Provider Demographics
NPI:1063962538
Name:CLINICA COACHELLA, INC
Entity type:Organization
Organization Name:CLINICA COACHELLA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATURONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-861-1436
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-0140
Mailing Address - Country:US
Mailing Address - Phone:760-861-1436
Mailing Address - Fax:760-289-6203
Practice Address - Street 1:51544 CESAR CHAVEZ ST STE 1D
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1504
Practice Address - Country:US
Practice Address - Phone:760-861-1436
Practice Address - Fax:760-289-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA977985261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275743932Medicare UPIN
CA1245302579Medicare UPIN