NPIMap

Organization Active NPI

Senior's Choice Medical Group, Inc.

  • Family Medicine Physician
  • Fontana, CA
National Provider Identifier
1023506672
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SENIOR'S CHOICE MEDICAL GROUP, INC.
Practice address
8990 Sierra Avenue
Suite J&K
Fontana, CA 92335-4772
Phone
(909) 421-4886
NPI assigned
Apr 30, 2018
Last updated
May 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guillermo J. Valenzuela, MDNPI 1730263484
Title
President
Phone
(909) 580-6333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

8990 Sierra Avenue
Suite J&K
Fontana, CA 92335-4772

Mailing address

PO Box 1762
Colton, CA 92324-0857
Phone (909) 580-6332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190308000448 CA Part B Supplier - Clinic/Group Practice 1557600582 Receives reassigned benefits from 3 practitioners
Practice locations: Fontana, CA

National Provider Directory

National Provider Directory

Locations

416 W Foothill Blvd
Rialto, CA 92376
Phone (909) 421-0493

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1023506672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1762",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923240857",
            "telephone_number": "909-580-6332",
            "fax_number": "909-580-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 SIERRA AVENUE",
            "address_2": "SUITE J&K",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354772",
            "telephone_number": "909-421-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR'S CHOICE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-30",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "VALENZUELA",
        "authorized_official_first_name": "GUILLERMO",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-580-6333",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.