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General NPI Number Information
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NPI Number | 1801991450
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Entity Type | Organization
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Legal Business Name | COLTON VALLEY MEDICAL GROUP
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 502 W VALLEY BLVD
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-825-3202
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Fax | 909-825-9375
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Provider Business Mailing Address
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Address Line | 502 W VALLEY BLVD
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-825-3202
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Fax | 909-825-9375
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Authorized Official
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Title or Position | PRESIDENT
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Name | WAGIAN SUN
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Credential | MD
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Telephone | 909-825-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A23744
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License Number State | CA
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