MEDICARE: VALLEJOS AND PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT23546	CA

General Provider Information

NPI Number	:	1265529242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEJOS AND PEREZ

Provider Business Mailing Address
First Line	:	5658 HUNT CLUB DR
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-1135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4295 JURUPA ST
Second Line	:	SUITE 108
City	:	ONTARIO
State	:	CA
Zip	:	91761-1428
Country	:	US
Telephone Number	:	909-937-7100
Fax Number	:

Authorized Official
Title or Position	:	OWNER / OFFICE MANAGER
Name	:	JOSE VALLEJOS
Credential	:
Telephone Number	:	909-937-7100

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	08/22/2020

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