| Organization Name: | COLTON VALLEY MEDICAL GROUP |
| NPI Number: | 1801991450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WAGIAN SUN (PRESIDENT) |
| Mailing Address: | 502 W Valley Blvd Colton |
| State: | CA US |
| Postal Code: | 92324 |
| Phone Number: | 9098253202 |
| Fax Number: | 9098259375 |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A23744 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |