NPIMap

Organization Active NPI

Heritage Victor Valley Medical Group

  • Multi-Specialty Clinic/Center
  • Victorville, CA
National Provider Identifier
1902356561
Registry record updated Oct 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
HERITAGE VICTOR VALLEY MEDICAL GROUP
Practice address
12370 Hesperia Rd
Suite 28
Victorville, CA 92395-7719
Phone
(714) 456-6966
Fax
(714) 456-8284
NPI assigned
Oct 7, 2016
Organization subpart
Yes
Parent organization
REGENTS OF THE UNIVERSITY OF CALIFORNIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2016

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

Authorized official

Name
Dr. Manuel Porto, M.D.
Title
President
Phone
(714) 456-2986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

12370 Hesperia Rd
Suite 28
Victorville, CA 92395-7719

Mailing address

PO Box 54840
Los Angeles, CA 90054-0840
Phone (714) 456-3856

National Provider Directory

National Provider Directory
Tax ID family
Heritage Victor Valley Medical Group5 organizations share this tax ID, including this one
Part of
Regents of the University of California

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12370 Hesperia Rd
Ste 28
Victorville, CA 92395
Phone (714) 456-6966

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475798400000",
    "number": "1902356561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54840",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900540840",
            "telephone_number": "714-456-3856",
            "fax_number": "714-456-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12370 HESPERIA RD",
            "address_2": "SUITE 28",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957719",
            "telephone_number": "714-456-6966",
            "fax_number": "714-456-8284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE VICTOR VALLEY MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENTS OF THE UNIVERSITY OF CALIFORNIA",
        "enumeration_date": "2016-10-07",
        "last_updated": "2016-10-07",
        "status": "A",
        "authorized_official_last_name": "PORTO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-456-2986",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "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 Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.