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Organization
PERRIS VALLEY MEDICAL GROUP, INC.
Active
Organization
PERRIS VALLEY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE VILLANUEVA (PRESIDENT)
(951) 657-0544
Entity
Organization
Contact information
Practice address
126 AVOCADO AVE, SUITE 207, PERRIS, CA 92571-2605
(951) 657-0544
(951) 657-9644
Mailing address
126 AVOCADO AVE, SUITE 207, PERRIS, CA 92571-2605
(951) 657-0544
(951) 657-9644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A6023
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E90354
—
CA
Enumeration date
01/16/2009
Last updated
02/09/2012
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