Healthcare Provider Details

I. General information

NPI: 1952485641
Provider Name (Legal Business Name): VALENZUELA MEDICAL GROUP I, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24226 SUNNYMEAD BLVD
MORENO VALLEY CA
92553-7739
US

IV. Provider business mailing address

595 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1201
US

V. Phone/Fax

Practice location:
  • Phone: 951-601-6802
  • Fax: 951-601-9263
Mailing address:
  • Phone: 909-889-8680
  • Fax: 909-888-5830

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUILLERMO J. VALENZUELA
Title or Position: PRESIDENT
Credential:
Phone: 909-580-3470