| Imperial Valley Endocrine Medical Corporation | |
|
528 G St Brawley CA 92227-2411 | |
| (760) 344-6355 | |
| (760) 344-6921 |
| Full Name | Imperial Valley Endocrine Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 528 G St, Brawley, California |
| Authorized Official Name and Position | Ramona A Krutzik (CEO) |
| Authorized Official Contact | 7603441881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imperial Valley Endocrine Medical Corporation 528 G St Brawley CA 92227-2411 Ph: (760) 344-6355 | Imperial Valley Endocrine Medical Corporation 528 G St Brawley CA 92227-2411 Ph: (760) 344-6355 |
| NPI Number | 1265623524 |
|---|---|
| Provider Enumeration Date | 08/01/2007 |
| Last Update Date | 01/16/2008 |
| Medicare PECOS PAC ID | 0042309437 |
|---|---|
| Medicare Enrollment ID | O20071207000864 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265623524 | NPI | - | NPPES |
| 00A708120 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | A70812 (California) | Primary |
| Provider Name | Ramona A Krutzik |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1881779296 PECOS PAC ID: 3678556735 Enrollment ID: I20040609001485 |
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