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General NPI Number Information
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NPI Number | 1023651445
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Entity Type | Organization
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Legal Business Name | CHINO VASCULAR & SURGERY CENTER INC
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 11760 CENTRAL AVE STE 204
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City | CHINO
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State | CA
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Zip | 91710-1909
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Country | US
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Telephone | 714-754-1684
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Fax | 714-966-0417
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Provider Business Mailing Address
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Address Line | 2621 S BRISTOL ST STE 108
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City | SANTA ANA
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State | CA
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Zip | 92704-5718
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Country | US
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Telephone | 714-754-1684
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANIL SHAH
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Credential | MD
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Telephone | 714-754-1684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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