HERITAGE VICTOR VALLEY MEDICAL GROUP (NPI# 1649506759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649506759 |
| Entity Type | Organization |
| Organization Name | HERITAGE VICTOR VALLEY MEDICAL GROUP |
| Practice Address |
12408 Hesperia Rd #2 Victorville CA 92395-7718 |
| Mailing Address |
9276 Scranton Rd Suite 100 San Diego CA 92121-7701 |
| Practice Telephone | 7602454747 |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2015-11-30 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | 54968 | CA | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902356561 | Heritage Victor Valley Medical Group | Clinic/Center | 12370 Hesperia Rd, Suite 28, Victorville, CA 92395-7719 | 2016-10-07 |
| Street Address |
12408 HESPERIA RD #2 |
| City | VICTORVILLE |
| State | CA |
| Zip Code | 92395-7718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134125321 | Curtis C Hoggarth | Optometrist | 12408 Hesperia Rd, Suite 7, Victorville, CA 92395-7718 | 2005-06-22 |
| 1538539002 | Erin Hosty Lechner | Registered Nurse | 12408 Hesperia Rd, Suite 2, Victorville, CA 92395-7718 | 2015-09-28 |
| 1841521366 | Christopher Michael Tran | Physician Assistant | 12408 Hesperia Rd, 2, Victorville, CA 92395-7718 | 2010-01-22 |
| 1104155761 | Brent Arthur North | Physician Assistant | 12408 Hesperia Rd, Suite 2, Victorville, CA 92395-7718 | 2009-12-10 |
| 1831350131 | Tiffany T. Tran | Family Medicine | 12408 Hesperia Rd, Suite 2, Victorville, CA 92395-7718 | 2008-06-19 |
| 1518055490 | Neal S. Blank | Family Medicine | 12408 Hesperia Rd, Suite 2, Victorville, CA 92395-7718 | 2006-10-10 |
| 1285669671 | Michio Abe | Internal Medicine | 12408 Hesperia Rd, Suite 21, Victorville, CA 92395-7718 | 2006-07-12 |
| 1871551564 | Wendell E Wettstein | General Practice | 12408 Hesperia Rd, Suite 2, Victorville, CA 92395-7718 | 2006-05-02 |
| 1851350771 | Prakash K Yakkundi | Internal Medicine | 12408 Hesperia Rd, Suite 2, Victorville, CA 92395-7718 | 2006-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837966 | Desert Ridge Transitional Care Center, Lp | Skilled Nursing Facility | 13300 11th Avenue, Victorville, CA 92395 | 2020-06-26 |
| 1376179093 | Catherine Ward | Speech-Language Pathologist | 13275 Mauka Ct, Victorville, CA 92395 | 2020-03-13 |
| 1174019228 | Laura Mercado Halterman | Family Medicine | 16519 Victor St Ste 307, Victorville, CA 92395 | 2018-07-02 |
| 1306337829 | Stephanie Ann Kruger | Behavior Technician | Sunny Days Inc 3602 Inland Empire Blvd., Ontario, CA 92395 | 2018-05-21 |
| 1861903924 | Debra L Andersen | Clinic/Center | 12830 Hesperia Road, Suite C, D, E, Victorville, CALIFORNIA 92395 | 2017-10-17 |
| 1790202141 | Joshua Powers | Physician Assistant | 12550 Hesperia Rd Ste 101, Victorville, CA 92395 | 2017-08-26 |
| 1043759491 | Kemp Individual & Family Therapy, Inc. | Marriage & Family Therapist | 14075 Hesperia Road, Suite 101, Victorville, CA 92395 | 2017-02-17 |
| 1740725969 | Abem Transportation Inc | Non-emergency Medical Transport (VAN) | 15000 7th St Ste F208, Victorville, CA 92395 | 2016-12-23 |
| 1447669379 | Tracie Girard | Nurse Practitioner | 17330 Bear Valley Road, Suite A106, Victorville, CA 92395 | 2014-08-05 |
| 1093153215 | Mitesh Patel | Surgery | 13010 Hesperia Rd Ste 400, Victorville, CA 92395 | 2013-06-10 |
| Find all providers in zip 92395 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134506769 | Joseph M Molina Md Professional Corporation Southern California | Non-Pharmacy Dispensing Site | 14544 7th St, Victorville, CA 92395-4214 | 2015-05-04 |
| 1871800961 | Choice Medical Group | Non-Pharmacy Dispensing Site | 13010 Hesperia Rd, 600, Victorville, CA 92395-5837 | 2010-09-10 |
| 1205021581 | High Desert Primary Care | Non-Pharmacy Dispensing Site | 12550 Hesperia Rd, Victorville, CA 92395-5873 | 2007-09-11 |
| 1376685263 | Yvonne Telgt-mckinney, Md Inc. | Non-Pharmacy Dispensing Site | 15366 11th St, O, Victorville, CA 92395-3726 | 2007-02-14 |
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| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| Find all providers with the same taxonomy | ||||
| City | VICTORVILLE |
| Zip Code | 92395 |
Please comment or provide details below to improve the information on HERITAGE VICTOR VALLEY MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.