# TRI-VALLEY NEONATAL MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497847305
- **Authorized official:** KARA NORDBERG (ACCOUNTS ADMINISTRATOR)
- **Authorized official phone:** (949) 492-3514

## Contact information

- **Practice address:** 15107 VANOWEN ST, VAN NUYS, CA 91405-4542
- **Practice address phone:** (818) 902-2978
- **Mailing address:** PO BOX 1359, SAN CLEMENTE, CA 92674-1359
- **Mailing address phone:** (949) 492-3514
- **Mailing address fax:** (949) 366-2390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | Yes |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 02/08/2010