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General NPI Number Information
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NPI Number | 1063553600
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Entity Type | Organization
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Legal Business Name | VALIANT MEDICAL GROUP A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 8239 ROCHESTER AVE STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0715
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Country | US
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Telephone | 909-941-0266
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Fax | 909-941-0569
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Provider Business Mailing Address
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Address Line | 8239 ROCHESTER AVE STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0715
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Country | US
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Telephone | 909-941-0266
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Fax | 909-941-0569
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOEY MARIE SABBAGH
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Credential |
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Telephone | 909-664-3734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A7546
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License Number State | CA
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