Healthcare Provider Details

I. General information

NPI: 1285971010
Provider Name (Legal Business Name): VALENTINE MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 GARFIELD ST STE 6
RIVERSIDE CA
92503-3922
US

IV. Provider business mailing address

8990 GARFIELD ST STE 6
RIVERSIDE CA
92503-3922
US

V. Phone/Fax

Practice location:
  • Phone: 951-343-1616
  • Fax: 951-343-1666
Mailing address:
  • Phone: 951-343-1616
  • Fax: 951-343-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA93662
License Number StateCA

VIII. Authorized Official

Name: DR. VALENTINE UGWUMBA OTUECHERE
Title or Position: OWNER
Credential: M.D.
Phone: 951-343-1616