Organization Active NPI

Mommy and Me Medical Group, Inc.

  • Family Medicine Physician
  • Riverside, CA
National Provider Identifier
1730258765
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOMMY AND ME MEDICAL GROUP, INC.
Practice address
4190 Chicago Ave
Riverside, CA 92507-5348
Phone
(951) 683-2106
NPI assigned
Nov 6, 2006
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
Dr. Guillermo J. Valenzuela, MD
Title
President
Phone
(909) 580-0633

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

4190 Chicago Ave
Riverside, CA 92507-5348

Mailing address

PO Box 1762
Colton, CA 92324-0857
Phone (909) 580-3470

Other practice location 1

416 W Foothill Blvd
Rialto, CA 92376-4953
Phone (909) 421-0493

Other practice location 2

498 W 4th St
Perris, CA 92570-2070
Phone (951) 943-8899

Other practice location 3

1688 N Perris Blvd Ste H4
Perris, CA 92571-4746
Phone (951) 657-7876

Other practice location 4

1711 Orange St
Redlands, CA 92374-2254
Phone (909) 792-2200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090730000546 CA Part B Supplier - Clinic/Group Practice 0244383727 Receives reassigned benefits from 25 practitioners
Practice locations: Perris, CA; Redlands, CA; Rialto, CA; Riverside, CA

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
05D1025759Mommy and Me Medical Group Inc1711 N Orange St, Redlands, CA 92374Certificate of waiverMay 16, 2028
05D1063824Mommy & Me Medical Group Inc.4190 Chicago Ave, Riverside, CA 92507Certificate of waiverJan 22, 2027
05D1084335Mommy and Me Medical Group Inc498 W 4TH St, Perris, CA 92570Certificate of waiverMay 19, 2028
05D2005860Mommy and Me Medical Group, Inc416 W Foothill Blvd, Rialto, CA 92376Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory

Locations

1688 N Perris Blvd
#4C
Perris, CA 92571

1688 N Perris Blvd
Ste H4
Perris, CA 92571
Phone (951) 657-7876

1711 Orange St
Redlands, CA 92374
Phone (909) 792-2200

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

1744 University Ave
#60
Riverside, CA 92507
Phone (951) 683-2106

1744 University Ave
Ste 100
Riverside, CA 92507
Phone (951) 243-5586

595 N Arrowhead Ave
Sn Bernrdno, CA 92401

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": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1730258765",
    "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": "909-580-3470",
            "fax_number": "909-580-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 CHICAGO AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925075348",
            "telephone_number": "951-683-2106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "416 W Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "Rialto",
            "state": "CA",
            "postal_code": "923764953",
            "country_code": "US",
            "telephone_number": "909-421-0493",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "498 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Perris",
            "state": "CA",
            "postal_code": "925702070",
            "country_code": "US",
            "telephone_number": "951-943-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1688 N Perris Blvd Ste H4",
            "address_purpose": "LOCATION",
            "city": "Perris",
            "state": "CA",
            "postal_code": "925714746",
            "country_code": "US",
            "telephone_number": "951-657-7876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 Orange St",
            "address_purpose": "LOCATION",
            "city": "Redlands",
            "state": "CA",
            "postal_code": "923742254",
            "country_code": "US",
            "telephone_number": "909-792-2200",
            "fax_number": "909-790-2660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOMMY AND ME MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "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": "909-580-0633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, 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.
  • 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.