Perris Valley Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A6023 Issued in CA

Legal business name

PERRIS VALLEY MEDICAL GROUP, INC.

Practice address

126 Avocado Ave
Suite 207
Perris, CA 92571-2605

Phone

(951) 657-0544

Fax

(951) 657-9644

NPI assigned

Jan 16, 2009

Organization subpart

No

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

Authorized official

Name

George VillanuevaNPI 1427132620

Title

President

Phone

(951) 657-0544

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• George Villanueva, DO

  • Family Medicine Physician
  • Perris, CA
  • NPI 1427132620
  Medicare reassignment Care Compare group NPD Authorized official
• Michael Villaverde Villanueva, PA-C

  • Physician Assistant
  • Perris, CA
  • NPI 1316909757
  Medicare reassignment Care Compare group
• Dimitri Villanueva

  • Family Medicine Physician
  • Perris, CA
  • NPI 1285337568
  NPD

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1083851703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 AVOCADO AVE",
            "address_2": "SUITE 207",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925712605",
            "telephone_number": "951-657-0544",
            "fax_number": "951-657-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 AVOCADO AVE",
            "address_2": "SUITE 207",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925712605",
            "telephone_number": "951-657-0544",
            "fax_number": "951-657-9644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRIS VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-16",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-657-0544"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E90354",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Perris Oasis, Incorporated
• Perris Recuperative Care LLC
• Perris Union High School District
• Perris Valley Community Hospital LLC
• Perris Valley Community Hospital, LLC
• Perris Valley Physicians Associates, a Medical Corp.
• Perris Valley Recovery Program, Inc.
• Alicia Perry
• Perris Peterson
• Phonmany Phengphavong

• Family Medicine Physician in Perris, CA
• Providers in Perris, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.