| South Bay Family Medical Group, Inc | |
|
584 E St Chula Vista CA 91910-2348 | |
| (619) 420-1378 | |
| (619) 420-1331 |
| Full Name | South Bay Family Medical Group, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 584 E St, Chula Vista, California |
| Authorized Official Name and Position | Efrain T Valladolid (PRESIDENT) |
| Authorized Official Contact | 6194201378 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Bay Family Medical Group, Inc 584 E St Chula Vista CA 91910-2348 Ph: (619) 420-1378 | South Bay Family Medical Group, Inc 584 E St Chula Vista CA 91910-2348 Ph: (619) 420-1378 |
| NPI Number | 1508920984 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 03/02/2011 |
| Medicare PECOS PAC ID | 6800954249 |
|---|---|
| Medicare Enrollment ID | O20081029000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508920984 | NPI | - | NPPES |
| 00A614740 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A61474 (California) | Primary |
| Provider Name | Efrain Torres Valladolid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407051782 PECOS PAC ID: 9436186012 Enrollment ID: I20110429000617 |
| Provider Name | Gloria Hernandez Silerio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861884132 PECOS PAC ID: 2365740495 Enrollment ID: I20160406000424 |
| Provider Name | Gabriella Miranda Miranda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194593350 PECOS PAC ID: 4486094588 Enrollment ID: I20240506001564 |
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