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General NPI Number Information
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NPI Number | 1255738241
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA PICC PROVIDERS, INC.
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 5787 LITTLE SHAY DR
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City | FONTANA
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State | CA
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Zip | 92336
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Country | US
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Telephone | 909-251-7730
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Fax | 909-251-7735
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Provider Business Mailing Address
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Address Line | 5787 LITTLE SHAY DR
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City | FONTANA
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State | CA
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Zip | 92336-4593
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Country | US
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Telephone | 909-251-7730
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Fax | 909-251-7735
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Authorized Official
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Title or Position | MEMBER OF THE BOARD
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Name | MARIA CATHERINE KOH CHUA
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Credential |
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Telephone | 909-945-9899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246XC2903X
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Taxonomy Name | Vascular Specialist/Technologist Cardiovascular
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License Number |
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License Number State |
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