Provider Demographics
NPI:1740667179
Name:PALO VERDE HEALTH CARE DISTRICT
Entity type:Organization
Organization Name:PALO VERDE HEALTH CARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE LEADERSHIP ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-921-5150
Mailing Address - Street 1:250 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1702
Mailing Address - Country:US
Mailing Address - Phone:760-922-4115
Mailing Address - Fax:760-921-5263
Practice Address - Street 1:291 N SECOND STREET
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1777
Practice Address - Country:US
Practice Address - Phone:760-922-4115
Practice Address - Fax:760-921-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40423HMedicaid
CA3701936Medicare PIN