# COLTON VALLEY MEDICAL GROUP

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

## Provider details

- **NPI number:** 1801991450
- **Authorized official:** WAGIAN SUN MD (PRESIDENT)
- **Authorized official phone:** (909) 825-3202

## Contact information

- **Practice address:** 502 W VALLEY BLVD, COLTON, CA 92324
- **Practice address phone:** (909) 825-3202
- **Practice address fax:** (909) 825-9375
- **Mailing address:** 502 W VALLEY BLVD, COLTON, CA 92324
- **Mailing address phone:** (909) 825-3202
- **Mailing address fax:** (909) 825-9375

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A23744 | CA | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A237440 | — | CA |
| 05 | — | GR0041960 | — | CA |