Organization · NPI-2

Fountain Valley Group Services PC

Internal Medicine, Critical Care Medicine · Indio, CA

NPI number1194670349
StatusActive
Last updated in NPPESAug 13, 2026

Details

NPI
1194670349
Entity type
Organization (NPI-2)
Legal business name
Fountain Valley Group Services PC
Organization subpart
No
Enumeration date
Mar 3, 2026
Certification date
Aug 13, 2026
Last updated
Aug 13, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RC0200X Internal Medicine, Critical Care Medicine––Yes

Practice location

47111 Monroe St
Indio, CA 92201-6739

Phone 760-347-6191

Mailing address

Po Box 20441
Belfast, ME 04915-4099

Authorized official

Kim H Larsen
Vp, Credentialing
7708745468

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