| Cucamonga Valley Medical Group, Inc. | |
|
16465 Sierra Lakes Parkway #300 Fontana CA 92336 | |
| (909) 429-2864 | |
| (909) 429-2868 |
| Full Name | Cucamonga Valley Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 16465 Sierra Lakes Parkway, Fontana, California |
| Authorized Official Name and Position | Kyle Nelson Smart (PRESIDENT) |
| Authorized Official Contact | 9094292864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cucamonga Valley Medical Group, Inc. 16465 Sierra Lakes Parkway #300 Fontana CA 92336 Ph: (909) 429-2864 | Cucamonga Valley Medical Group, Inc. 16465 Sierra Lakes Parkway #300 Fontana CA 92336 Ph: (909) 429-2864 |
| NPI Number | 1497783229 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 04/29/2013 |
| Medicare PECOS PAC ID | 6709899883 |
|---|---|
| Medicare Enrollment ID | O20060712000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497783229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 858582 (Maine) | Primary |
| Provider Name | Muhammad R Mowjood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851389464 PECOS PAC ID: 6800857129 Enrollment ID: I20041020000949 |
| Provider Name | Kyle N Smart |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821030057 PECOS PAC ID: 7618994914 Enrollment ID: I20051026000661 |
| Provider Name | Jesse S Dominguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467534313 PECOS PAC ID: 2961581491 Enrollment ID: I20080508000307 |
| Provider Name | Kimberly Bekemeier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073710489 PECOS PAC ID: 7416140322 Enrollment ID: I20101025000231 |
| Provider Name | Brandon Tong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508151036 PECOS PAC ID: 7113144130 Enrollment ID: I20140814000732 |
| Provider Name | Mirelle Ann M Ignacio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639350416 PECOS PAC ID: 9830378447 Enrollment ID: I20140915002520 |
| Provider Name | Paola L Yanez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790360659 PECOS PAC ID: 2264836907 Enrollment ID: I20210803002424 |
| Provider Name | Kiranjeet Kaur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336811561 PECOS PAC ID: 3971993262 Enrollment ID: I20211130002119 |
| Provider Name | Ayman Fakeh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245469345 PECOS PAC ID: 6103080817 Enrollment ID: I20211207001863 |
| Provider Name | Rishma Viren Bhatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255000493 PECOS PAC ID: 8426440561 Enrollment ID: I20220121000917 |
| Provider Name | Noe Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962936930 PECOS PAC ID: 3274920160 Enrollment ID: I20220422002011 |
| Provider Name | Tiffany De Jesus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447799739 PECOS PAC ID: 7911369475 Enrollment ID: I20230815002543 |
| Provider Name | Sarah Elizabeth Tamayo-perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548634744 PECOS PAC ID: 7517389943 Enrollment ID: I20230829001699 |
| Provider Name | Carla Iris Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518470921 PECOS PAC ID: 1355763780 Enrollment ID: I20231214002075 |
| Provider Name | Maureen Nwaobilor Iwuoha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790550440 PECOS PAC ID: 1658715305 Enrollment ID: I20240221001198 |
| Provider Name | Peter Dung-quoc Doan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639791452 PECOS PAC ID: 9436567849 Enrollment ID: I20240419002680 |
| Provider Name | Tawanda Lucille Elam-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689407926 PECOS PAC ID: 5799219697 Enrollment ID: I20241114003377 |
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Alav Medical Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16465 Sierra Lakes Pkwy, Ste 220, Fontana, CA 92336 Phone: 909-434-1123 Fax: 909-261-8082 | |
Vituity Physician Services Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16888 Baseline Ave, Fontana, CA 92336 Phone: 855-422-8029 | |
Internal Medicine Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16465 Sierra Lakes Parkway, Internal Medicine Medical Group Suite, Fontana, CA 92336 Phone: 909-770-8640 Fax: 909-770-8650 |