| Heritage Victor Valley Medical Group | |
|
12370 Hesperia Rd Suite 6 Victorville CA 92395-7719 | |
| (760) 245-4747 | |
| (760) 245-4868 |
| Full Name | Heritage Victor Valley Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 12370 Hesperia Rd, Victorville, California |
| Authorized Official Name and Position | Martha Paredes (BILLING MANAGER) |
| Authorized Official Contact | 6617263819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Victor Valley Medical Group Po Box 7020 Lancaster CA 93539-7020 Ph: (661) 726-3819 | Heritage Victor Valley Medical Group 12370 Hesperia Rd Suite 6 Victorville CA 92395-7719 Ph: (760) 245-4747 |
| NPI Number | 1295126001 |
|---|---|
| Provider Enumeration Date | 02/16/2015 |
| Last Update Date | 02/27/2024 |
| Medicare PECOS PAC ID | 5092185546 |
|---|---|
| Medicare Enrollment ID | O20221228001648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295126001 | NPI | - | NPPES |
| Provider Name | Roger A Moushabek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073541157 PECOS PAC ID: 7719959162 Enrollment ID: I20040806001200 |
| Provider Name | Amir H Hedayati-rad |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1861410029 PECOS PAC ID: 3971571332 Enrollment ID: I20040924000465 |
| Provider Name | Eloise Skelton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285774661 PECOS PAC ID: 6002885522 Enrollment ID: I20040930000546 |
| Provider Name | Curtis C Hoggarth |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134125321 PECOS PAC ID: 1355393646 Enrollment ID: I20050413000892 |
| Provider Name | Ziad R Sawan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1912958786 PECOS PAC ID: 5496812695 Enrollment ID: I20120106000195 |
| Provider Name | Marlon S Russell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497039119 PECOS PAC ID: 3072766807 Enrollment ID: I20130103000437 |
| Provider Name | Katan Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811216989 PECOS PAC ID: 3870714322 Enrollment ID: I20141027000001 |
| Provider Name | David J. Horner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407112923 PECOS PAC ID: 6709100415 Enrollment ID: I20160727001445 |
| Provider Name | Sourav Das |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174805279 PECOS PAC ID: 2860614617 Enrollment ID: I20160923002045 |
| Provider Name | Chansa Cha |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477853265 PECOS PAC ID: 9638308372 Enrollment ID: I20170921003196 |
| Provider Name | Rachel Marie Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366969867 PECOS PAC ID: 0446525505 Enrollment ID: I20170929001428 |
| Provider Name | Kenneth D Terry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144712902 PECOS PAC ID: 7719312057 Enrollment ID: I20200115001604 |
| Provider Name | Williane D Mendiola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821577743 PECOS PAC ID: 7719225424 Enrollment ID: I20200207000920 |
| Provider Name | Cynthia Diane Raymond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508226663 PECOS PAC ID: 0042693731 Enrollment ID: I20220812001295 |
| Provider Name | Elizabeth Suwartono Pagler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295185254 PECOS PAC ID: 1658669221 Enrollment ID: I20230306001482 |
| Provider Name | Randolph Flores Leon Guerrero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184689671 PECOS PAC ID: 9436280997 Enrollment ID: I20230306001990 |
| Provider Name | Fadi Samir Tahhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477177798 PECOS PAC ID: 0244674828 Enrollment ID: I20240222001871 |
| Provider Name | Jeremy E Lucero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720660293 PECOS PAC ID: 4082052899 Enrollment ID: I20240328004088 |
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