Provider Demographics
NPI:1780749051
Name:NACO MEDICAL GROUP
Entity type:Organization
Organization Name:NACO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGILIO
Authorized Official - Middle Name:V
Authorized Official - Last Name:NACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-619-3719
Mailing Address - Street 1:15203 11TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3737
Mailing Address - Country:US
Mailing Address - Phone:760-245-3719
Mailing Address - Fax:760-951-1626
Practice Address - Street 1:15203 11TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3737
Practice Address - Country:US
Practice Address - Phone:760-245-3719
Practice Address - Fax:760-951-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30874261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26264Medicare UPIN