# PERFORMANCE MEDICAL GROUP

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

## Provider details

- **NPI number:** 1629314661
- **Authorized official:** LEE FREIRE (OFFICE MANAGER)
- **Authorized official phone:** (760) 242-5055

## Contact information

- **Practice address:** 16130 KOKANEE RD STE 101, APPLE VALLEY, CA 92307-0833
- **Practice address phone:** (760) 242-5055
- **Practice address fax:** (760) 242-5466
- **Mailing address:** 16130 KOKANEE RD STE 101, APPLE VALLEY, CA 92307-0833
- **Mailing address phone:** (760) 242-5055
- **Mailing address fax:** (760) 242-5466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 12/19/2012
- **Last updated:** 12/19/2012