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General NPI Number Information
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NPI Number | 1194976563
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Entity Type | Organization
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Legal Business Name | CHW SO. CALIFORNIA
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | 681 N BRIERWOOD AVE
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City | RIALTO
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State | CA
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Zip | 92376-4776
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Country | US
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Telephone | 909-879-7803
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Fax |
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Provider Business Mailing Address
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Address Line | 681 N BRIERWOOD AVE
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City | RIALTO
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State | CA
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Zip | 92376-4776
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Country | US
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Telephone | 909-879-7803
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Fax |
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Authorized Official
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Title or Position | CHAIR FOR THE DEPARTMENT OF NURSING
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Name | MRS. FAYE BOWER
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Credential | DNSC, FAA
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Telephone | 510-436-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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