Provider Demographics
NPI:1225414592
Name:EL CENTRO MEDICAL REGIONAL CENTER
Entity Type:Organization
Organization Name:EL CENTRO MEDICAL REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO ALONSO
Authorized Official - Middle Name:MARROQUIN
Authorized Official - Last Name:COLIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:760-604-2528
Mailing Address - Street 1:947 SANTILLAN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3813
Mailing Address - Country:US
Mailing Address - Phone:760-604-2528
Mailing Address - Fax:
Practice Address - Street 1:1415 ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4306
Practice Address - Country:US
Practice Address - Phone:760-339-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002686282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital