Provider Demographics
NPI:1558472720
Name:VALLE VERDE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:VALLE VERDE MEDICAL GROUP INC
Other - Org Name:VALLE VERDE MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DOWER
Authorized Official - Last Name:SAGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-754-1544
Mailing Address - Street 1:1332 NATIVIDAD RD STE C
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3133
Mailing Address - Country:US
Mailing Address - Phone:831-754-1544
Mailing Address - Fax:831-754-2984
Practice Address - Street 1:1332 NATIVIDAD RD STE C
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3133
Practice Address - Country:US
Practice Address - Phone:831-754-1544
Practice Address - Fax:831-754-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558472720OtherNATIONAL PROVIDER IDENTIFIER
CAGR0091130OtherMEDI-CAL
1558472720OtherNATIONAL PROVIDER IDENTIFIER
CAF93472Medicare UPIN