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General NPI Number Information
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NPI Number | 1518972215
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Entity Type | Organization
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Legal Business Name | POMONA VALLEY PODIATRY GROUP INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 1212 N PARK AVE
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City | POMONA
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State | CA
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Zip | 91768-3029
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Country | US
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Telephone | 909-622-4501
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Fax | 909-632-1729
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Provider Business Mailing Address
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Address Line | 1212 N PARK AVE
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City | POMONA
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State | CA
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Zip | 91768-3029
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Country | US
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Telephone | 909-622-4501
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Fax | 909-632-1729
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN FREDERICK ONEILL
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Credential | DPM
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Telephone | 909-622-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E3029
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License Number State | CA
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