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General NPI Number Information
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NPI Number | 1124172796
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Entity Type | Organization
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Legal Business Name | MURRIETA VALLEY FAMILY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 24910 LAS BRISAS RD STE 121
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City | MURRIETA
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State | CA
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Zip | 92562-4035
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Country | US
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Telephone | 951-698-7550
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Fax | 951-698-1521
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Provider Business Mailing Address
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Address Line | 24910 LAS BRISAS RD STE 121
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City | MURRIETA
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State | CA
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Zip | 92562-4035
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Country | US
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Telephone | 951-698-7550
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Fax | 951-698-1521
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Authorized Official
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Title or Position | CEO
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Name | ROBERT G PETERSON
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Credential | M.D.
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Telephone | 951-698-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G453820
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License Number State | CA
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