Provider Demographics
NPI:1578611901
Name:CLINICAS DE SALUD DEL PUEBLO INC
Entity Type:Organization
Organization Name:CLINICAS DE SALUD DEL PUEBLO INC
Other - Org Name:INNERCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-344-9951
Mailing Address - Street 1:223 W COLE RD
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-9722
Mailing Address - Country:US
Mailing Address - Phone:760-357-2020
Mailing Address - Fax:760-357-1056
Practice Address - Street 1:223 W COLE BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9722
Practice Address - Country:US
Practice Address - Phone:760-357-2020
Practice Address - Fax:760-357-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33293302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD12509Medicare UPIN