Provider Demographics
NPI:1790921641
Name:CLINICA MEDICA DEL VALLE, INC.
Entity Type:Organization
Organization Name:CLINICA MEDICA DEL VALLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-398-0606
Mailing Address - Street 1:52-565 HARRISON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1534
Mailing Address - Country:US
Mailing Address - Phone:760-398-0606
Mailing Address - Fax:760-398-5507
Practice Address - Street 1:52-565 HARRISON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1534
Practice Address - Country:US
Practice Address - Phone:760-398-0606
Practice Address - Fax:760-398-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA665952086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty