Healthcare Provider Details

I. General information

NPI: 1023506672
Provider Name (Legal Business Name): SENIOR'S CHOICE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 SIERRA AVENUE SUITE J&K
FONTANA CA
92335-4772
US

IV. Provider business mailing address

PO BOX 1762
COLTON CA
92324-0857
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-4886
  • Fax:
Mailing address:
  • Phone: 909-580-6332
  • Fax: 909-580-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO J. VALENZUELA
Title or Position: PRESIDENT
Credential: MD
Phone: 909-580-6333