Healthcare Provider Details

I. General information

NPI: 1821373978
Provider Name (Legal Business Name): CHINO VALLEY ORTHOPEDIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13193 CENTRAL AVE SUITE 100
CHINO CA
91710-4179
US

IV. Provider business mailing address

39000 BOB HOPE DR SUITE K 209
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 909-464-9675
  • Fax: 909-590-3898
Mailing address:
  • Phone: 760-340-1003
  • Fax: 760-340-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SOHAIL S. AHMAD
Title or Position: OWNER/PRESIDENT
Credential: M. D.
Phone: 909-464-9675