Provider Demographics
NPI:1720454655
Name:VILLAGE MEDICAL GROUP
Entity Type:Organization
Organization Name:VILLAGE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SAMEER
Authorized Official - Last Name:PAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-651-8939
Mailing Address - Street 1:276 CHRUCH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2729
Mailing Address - Country:US
Mailing Address - Phone:619-651-8939
Mailing Address - Fax:619-362-9616
Practice Address - Street 1:276 CHRUCH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2729
Practice Address - Country:US
Practice Address - Phone:619-651-8939
Practice Address - Fax:619-362-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X, 171100000X, 208VP0000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty