Organization
HERITAGE VICTOR VALLEY MEDICAL GROUP
Active
Parent organization
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Organization subpart
Yes
Provider details
NPI number
Legal business name
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Authorized official
DR. MANUEL PORTO M.D. (PRESIDENT)
(714) 456-2986
Entity
Organization
Contact information
Practice address
12370 HESPERIA RD, SUITE 28, VICTORVILLE, CA 92395-7719
(714) 456-6966
(714) 456-8284
Mailing address
PO BOX 54840, LOS ANGELES, CA 90054-0840
(714) 456-3856
(714) 456-8101
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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