Provider Demographics
NPI:1811319890
Name:COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-534-2707
Mailing Address - Street 1:81767 DR CARREON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5599
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:866-544-2050
Practice Address - Street 1:81767 DR CARREON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5599
Practice Address - Country:US
Practice Address - Phone:760-775-4181
Practice Address - Fax:866-544-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty