Provider Demographics
NPI:1780779736
Name:VALLEY ORTHOPEDIC ASSOCIATES MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:VALLEY ORTHOPEDIC ASSOCIATES MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:SAMI
Authorized Official - Last Name:BOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-599-0881
Mailing Address - Street 1:627 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1208
Mailing Address - Country:US
Mailing Address - Phone:909-599-0881
Mailing Address - Fax:909-394-0701
Practice Address - Street 1:627 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1208
Practice Address - Country:US
Practice Address - Phone:909-599-0881
Practice Address - Fax:909-394-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A332620Medicaid
CA00A332620Medicaid
CAW18432Medicare ID - Type Unspecified