| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 176 S Palm Drive, Blythe, California |
| Authorized Official Name and Position | David Brooks (CEO) |
| Authorized Official Contact | 9609221020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
176 S Palm Drive Blythe CA 92225 Ph: (760) 922-1020 | 176 S Palm Drive Blythe CA 92225 Ph: (760) 922-1020 |
| NPI Number | 1326123399 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 01/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326123399 | NPI | - | NPPES |
| 00G115032 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G11503 (California) | Primary |
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