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Organization
VALLEY WIDE MEDICAL GROUP INC
Active
Organization
VALLEY WIDE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRABHAKAR TUMMALA MD (PRESIDENT)
(909) 945-7687
Entity
Organization
Contact information
Practice address
12500 BORON AVE, BORON, CA 93730
(760) 762-5111
(760) 762-5695
Mailing address
12500 BORON AVE, BORON, CA 93730
(760) 762-5111
(760) 762-5695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A89858
CA
Other
Enumeration date
01/29/2008
Last updated
06/23/2008
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