Provider Demographics
NPI:1710634084
Name:COMITE CIVICO DEL VALLE, INC.
Entity Type:Organization
Organization Name:COMITE CIVICO DEL VALLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-351-8761
Mailing Address - Street 1:235 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2350
Mailing Address - Country:US
Mailing Address - Phone:760-351-8761
Mailing Address - Fax:
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2350
Practice Address - Country:US
Practice Address - Phone:760-351-8761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty