Provider Demographics
NPI:1053820340
Name:VALENCIA FAMILY CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:VALENCIA FAMILY CARE MEDICAL GROUP
Other - Org Name:HIGH DESERT PEDIATRIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:760-952-3892
Mailing Address - Street 1:12677 HESPERIA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:760-952-3892
Mailing Address - Fax:855-490-7027
Practice Address - Street 1:12677 HESPERIA RD STE 150
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:760-952-3892
Practice Address - Fax:855-490-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537870Medicaid