Provider Demographics
NPI:1467213363
Name:COACHELLA CARE CLINIC
Entity Type:Organization
Organization Name:COACHELLA CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUSAMRAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-231-7173
Mailing Address - Street 1:71843 HIGHWAY 111 STE B
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4418
Mailing Address - Country:US
Mailing Address - Phone:909-543-5387
Mailing Address - Fax:
Practice Address - Street 1:71843 HIGHWAY 111 STE B
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4418
Practice Address - Country:US
Practice Address - Phone:760-610-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty