NPIMap

Organization Active NPI

Victorville Pediatrics

  • Pediatrics Physician
  • Victorville, CA
National Provider Identifier
1497249155
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
VICTORVILLE PEDIATRICS
Practice address
15237 Eleventh St Ste a
Victorville, CA 92395-3736
Phone
(909) 823-8000
Fax
(909) 823-8088
NPI assigned
Jun 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Dr. Namita Mohideen, MDNPI 1871543850
Title
Owner
Phone
(760) 662-7420

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

15237 Eleventh St Ste a
Victorville, CA 92395-3736

Mailing address

16465 Sierra Lakes Pkwy Ste 275
Fontana, CA 92336-1263
Phone (909) 823-8000

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
05D2153739Victorville Pediatrics15237 Eleventh Street Suite a, Victorville, CA 92395Certificate of waiverAug 28, 2026

National Provider Directory

National Provider Directory

Locations

18523 Corwin Rd
Apple Valley, CA 92307
Phone (909) 712-2764

15237 Eleventh St
Victorville, CA 92395
Phone (619) 245-0162

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1529193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1497249155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 275",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361263",
            "telephone_number": "909-823-8000",
            "fax_number": "909-823-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15237 ELEVENTH ST STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953736",
            "telephone_number": "909-823-8000",
            "fax_number": "909-823-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORVILLE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-17",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "MOHIDEEN",
        "authorized_official_first_name": "NAMITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-662-7420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.