MEDICARE: VALLEY MISSION MEDICAL

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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699818278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY MISSION MEDICAL

Provider Business Mailing Address
First Line	:	PO BOX 5280
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92615-5280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 VAN NUYS BLVD
Second Line	:	STE B
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1449
Country	:	US
Telephone Number	:	818-908-2300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARILYN SHIEH
Credential	:
Telephone Number	:	818-908-2300

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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Directions to “VALLEY MISSION MEDICAL ” Practice Location

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