Healthcare Provider Details

I. General information

NPI: 1780779736
Provider Name (Legal Business Name): VALLEY ORTHOPEDIC ASSOCIATES MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 E FOOTHILL BLVD
SAN DIMAS CA
91773-1208
US

IV. Provider business mailing address

627 E FOOTHILL BLVD
SAN DIMAS CA
91773-1208
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-0881
  • Fax: 909-394-0701
Mailing address:
  • Phone: 909-599-0881
  • Fax: 909-394-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TONY SAMI BOUZ
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 909-599-0881