Provider Demographics
NPI:1649487067
Name:CARMEL VALLEY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:CARMEL VALLEY MEDICAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:831-626-4469
Mailing Address - Street 1:27880 DORRIS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8581
Mailing Address - Country:US
Mailing Address - Phone:831-626-4469
Mailing Address - Fax:831-626-6041
Practice Address - Street 1:27880 DORRIS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8581
Practice Address - Country:US
Practice Address - Phone:831-626-4469
Practice Address - Fax:831-626-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty