Provider Demographics
NPI:1336025162
Name:COUNTY OF IMPERIAL
Entity type:Organization
Organization Name:COUNTY OF IMPERIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHERIFF-CORONER-MARSHAL
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAMONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-265-2005
Mailing Address - Street 1:940 W. MAIN STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:328 APPLESTILL ROAD
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:442-265-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF IMPERIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1311LCDOC1312LCDOCMedicaid