Provider Demographics
NPI:1245972306
Name:VOLTA MEDICAL GROUP
Entity type:Organization
Organization Name:VOLTA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SETSOAFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-308-4550
Mailing Address - Street 1:9415 MISSION BLVD STE P
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2600
Mailing Address - Country:US
Mailing Address - Phone:833-865-8263
Mailing Address - Fax:
Practice Address - Street 1:9415 MISSION BLVD STE P
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-2600
Practice Address - Country:US
Practice Address - Phone:833-865-8263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care