Healthcare Provider Details

I. General information

NPI: 1730258765
Provider Name (Legal Business Name): MOMMY AND ME MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 CHICAGO AVE
RIVERSIDE CA
92507-5348
US

IV. Provider business mailing address

PO BOX 1762
COLTON CA
92324-0857
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-2106
  • Fax:
Mailing address:
  • Phone: 909-580-3470
  • Fax: 909-580-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUILLERMO J. VALENZUELA
Title or Position: PRESIDENT
Credential: MD
Phone: 909-580-0633