1023506672 NPI number — SENIOR'S CHOICE MEDICAL GROUP, INC.

Table of content: (NPI 1023506672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023506672 NPI number — SENIOR'S CHOICE MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR'S CHOICE MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023506672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1762
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92324-0857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-580-6332
Provider Business Mailing Address Fax Number:
909-580-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8990 SIERRA AVENUE
Provider Second Line Business Practice Location Address:
SUITE J&K
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92335-4772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-421-4886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VALENZUELA
Authorized Official First Name:
GUILLERMO
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-580-6333

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com