NPIMap

Organization Active NPI

Valle Verde Pediatrics Medical Group

  • Pediatrics Physician
  • Poway, CA
National Provider Identifier
1326131079
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
FNP18257 Issued in CA
Legal business name
VALLE VERDE PEDIATRICS MEDICAL GROUP
Practice address
15525 Pomerado Road
#B1
Poway, CA 92064-2465
Phone
(858) 487-8333
Fax
(858) 487-0856
NPI assigned
Oct 2, 2006
Last updated
Jan 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Authorized official

Name
Dr. Nathan Rendler, M.D.NPI 1275531337
Title
President
Phone
(858) 487-8333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 00G642310 CA
Pediatrics Physician 208000000X FNP18257 CA Primary

Addresses

Primary practice location

15525 Pomerado Road
#B1
Poway, CA 92064-2465

Mailing address

15525 Pomerado Road
#B1
Poway, CA 92064-2465
Phone (858) 487-8333

Other identifiers 1

IdentifierTypeStateIssuer
1326131079MedicaidCA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0568350Valle Verde Pediatrics Inc15525 Pomerado Rd Ste B-1, Poway, CA 92064Certificate of waiverMay 20, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1326131079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15525 POMERADO ROAD",
            "address_2": "#B1",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642465",
            "telephone_number": "858-487-8333",
            "fax_number": "858-487-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 POMERADO ROAD",
            "address_2": "#B1",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642465",
            "telephone_number": "858-487-8333",
            "fax_number": "858-487-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLE VERDE PEDIATRICS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-01-28",
        "status": "A",
        "authorized_official_last_name": "RENDLER",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-487-8333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "00G642310",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "FNP18257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326131079",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poway, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.