Healthcare Provider Details

I. General information

NPI: 1407615438
Provider Name (Legal Business Name): EVERSIDE HEALTH CHINO HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE STE 222
CHINO CA
91710-1408
US

IV. Provider business mailing address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

V. Phone/Fax

Practice location:
  • Phone: 909-781-6942
  • Fax:
Mailing address:
  • Phone: 909-781-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARLA SPIVEY
Title or Position: IMPLEMENTATION AND ONBOARDING COORD
Credential:
Phone: 317-869-3164