MEDICARE: VALIANT MEDICAL GROUP A PROFESSIONAL MEDICAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A7546	CA

General Provider Information

NPI Number	:	1063553600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALIANT MEDICAL GROUP A PROFESSIONAL MEDICAL CORP

Provider Business Mailing Address
First Line	:	8239 ROCHESTER AVE STE 120
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-0715
Country	:	US
Telephone Number	:	909-941-0266
Fax Number	:	909-941-0569

Provider Business Practice Location Address
First Line	:	8239 ROCHESTER AVE STE 120
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-0715
Country	:	US
Telephone Number	:	909-941-0266
Fax Number	:	909-941-0569

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JOEY MARIE SABBAGH
Credential	:
Telephone Number	:	909-664-3734

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	12/16/2024

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