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Organization
RIVERSIDE REGIONAL PEDIATRIC MEDICAL GROUP, INC.
Active
Organization
RIVERSIDE REGIONAL PEDIATRIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUILLERMO VALENZUELA M.D (PRESIDENT/OWNER)
(909) 580-6320
Entity
Organization
Contact information
Practice address
12712 HEACOCK ST STE 3, MORENO VALLEY, CA 92553-3037
(951) 601-6802
(951) 601-9302
Mailing address
12712 HEACOCK ST STE 3, MORENO VALLEY, CA 92553-3037
(951) 601-6802
(951) 601-9302
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0086161
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
10/17/2006
Last updated
08/22/2020
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