South Bay Family Medical Group, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A61474 Issued in CA

Legal business name

SOUTH BAY FAMILY MEDICAL GROUP, INC

Practice address

584 E St
Chula Vista, CA 91910-2348

Phone

(619) 420-1378

Fax

(619) 420-1331

NPI assigned

Dec 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Efrain T Valladolid Sr., M.D.NPI 1407051782

Title

President

Phone

(619) 420-1378

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13156/brand/1/csg/1/fhir/r4

Practitioners 4

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.

• Efrain Torres Valladolid, M.D.

  • Family Medicine Physician
  • Chula Vista, CA
  • NPI 1407051782
  Medicare reassignment NPD Authorized official
• Gloria Hernandez Silerio

  • Specialist
  • Chula Vista, CA
  • NPI 1861884132
  Medicare reassignment NPD
• Gabriella Miranda Miranda, FNP

  • Family Nurse Practitioner
  • Chula Vista, CA
  • NPI 1194593350
  Medicare reassignment NPD
• Thomas Delao Martinez Sr., M.D.

  • Family Medicine Physician
  • Chula Vista, CA
  • NPI 1851455216
  NPD

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299024000000",
    "number": "1508920984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "584 E ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102348",
            "telephone_number": "619-420-1378",
            "fax_number": "619-420-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "584 E ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102348",
            "telephone_number": "619-420-1378",
            "fax_number": "619-420-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY FAMILY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2011-03-02",
        "status": "A",
        "authorized_official_last_name": "VALLADOLID",
        "authorized_official_first_name": "EFRAIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-420-1378",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A61474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A614740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Bay Cardiology
• South Bay Community Services
• South Bay Community Services
• South Bay Community Services
• South Bay Endodontics
• South Bay Foot & Ankle Specialists, Inc.
• South Bay Geriatric and Internal Medicine Inc
• South Bay Hearing & Balance
• South Bay Internal Medical GRP Inc
• South Bay Internal Medicine and Family Practice Group Inc

• Family Medicine Physician in Chula Vista, CA
• Providers in Chula Vista, 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 Mar 2, 2011; 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.