Provider Demographics
NPI:1285395582
Name:GREEN VALLEY MEDICAL GROUP INC.
Entity type:Organization
Organization Name:GREEN VALLEY MEDICAL GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FLOR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-212-7978
Mailing Address - Street 1:132 ALTA STREET
Mailing Address - Street 2:
Mailing Address - City:GONSALEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93926-7977
Mailing Address - Country:US
Mailing Address - Phone:760-212-7978
Mailing Address - Fax:
Practice Address - Street 1:132 ALTA STREET
Practice Address - Street 2:
Practice Address - City:GONSALEZ
Practice Address - State:CA
Practice Address - Zip Code:93927-7977
Practice Address - Country:US
Practice Address - Phone:760-212-7978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA842252407Medicaid