Provider Demographics
NPI:1124485099
Name:COACHELLA VALLEY DIGESTIVE HEALTH INC.
Entity type:Organization
Organization Name:COACHELLA VALLEY DIGESTIVE HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJUMOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-801-0492
Mailing Address - Street 1:44489 TOWN CENTER WAY
Mailing Address - Street 2:SUITE D485
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47170 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2089
Practice Address - Country:US
Practice Address - Phone:760-771-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-24
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101199207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871777698Medicare PIN