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General NPI Number Information
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NPI Number | 1144682519
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Entity Type | Organization
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Legal Business Name | INTERCOMMUNITY ONCOLOGY OF CHINO HILLS APC INC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 13768 ROSWELL AVE 105
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City | CHINO
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State | CA
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Zip | 91710-1401
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Country | US
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Telephone | 909-591-0814
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Fax | 909-364-9929
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Provider Business Mailing Address
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Address Line | 13768 ROSWELL AVE 105
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City | CHINO
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State | CA
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Zip | 91710-1401
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Country | US
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Telephone | 909-591-0814
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Fax | 909-364-9929
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARIA BERG
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Credential |
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Telephone | 909-463-3489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A47961
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License Number State | CA
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