Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Vidal Luis Cordova Jr.

Individual provider Physician Assistant · NPI 1629694716

Mr. Vidal Luis Cordova Jr. is a Physician Assistant in Colton, California. Qualified in 2020, 6 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment.

Years since qualifying
6
In the registry since
2020
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Practice location Address checks out

400 N Pepper Ave
Colton, CA 92324-1801
Phone: (909) 557-1600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1629694716
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 24, 2020
Last updated in NPPESJanuary 13, 2023
Certification dateSeptember 16, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Colton