Basic Information
| Provider Information | |||||||||
| NPI: | 1023506672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR'S CHOICE MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1762 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923240857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095806332 | ||||||||
| FaxNumber: | 9095803289 | ||||||||
| Practice Location | |||||||||
| Address1: | 8990 SIERRA AVENUE | ||||||||
| Address2: | SUITE J&K | ||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923354772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094214886 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | VALENZUELA | ||||||||
| AuthorizedOfficialFirstName: | GUILLERMO | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9095806333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.