| Radiant Primary Care | |
|
17259 Jasmine St Suite B Victorville CA 92395-7787 | |
| (760) 241-4959 | |
| (760) 241-5950 |
| Full Name | Radiant Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 17259 Jasmine St, Victorville, California |
| Authorized Official Name and Position | Anupama Sharma (OWNER) |
| Authorized Official Contact | 7602414929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiant Primary Care Po Box 1384 Victorville CA 92393-1384 Ph: (760) 241-4929 | Radiant Primary Care 17259 Jasmine St Suite B Victorville CA 92395-7787 Ph: (760) 241-4959 |
| NPI Number | 1922212653 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 09/28/2011 |
| Medicare PECOS PAC ID | 6406993781 |
|---|---|
| Medicare Enrollment ID | O20091019000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922212653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| Provider Name | Anupama Sharma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851387948 PECOS PAC ID: 0042112856 Enrollment ID: I20040122000877 |
| Provider Name | Michael D Jasso |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356404305 PECOS PAC ID: 0042496788 Enrollment ID: I20110516000082 |
| Provider Name | Joshua N Powers |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1790202141 PECOS PAC ID: 9739446865 Enrollment ID: I20171128002727 |
| Provider Name | Ester Victoria Barraza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588158711 PECOS PAC ID: 5799028429 Enrollment ID: I20230612002853 |
| Provider Name | Veronica Portillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255014965 PECOS PAC ID: 7618322652 Enrollment ID: I20231011003816 |
| Provider Name | Sean Cody |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639813009 PECOS PAC ID: 7618487398 Enrollment ID: I20250611002117 |
| Provider Name | Aditya Devineni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497499909 PECOS PAC ID: 2860908993 Enrollment ID: I20250724000083 |
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