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General NPI Number Information
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NPI Number | 1710321856
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Entity Type | Organization
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Legal Business Name | COLINA MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 255 E BONITA AVE
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City | POMONA
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State | CA
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Zip | 91767-1923
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Country | US
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Telephone | 909-450-0170
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Fax | 909-596-0153
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Provider Business Mailing Address
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Address Line | 255 E BONITA AVE
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City | POMONA
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State | CA
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Zip | 91767-1923
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Country | US
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Telephone | 909-450-0170
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Fax | 909-596-0153
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHRISTOPHER CHALIAN
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Credential | M.D.
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Telephone | 909-706-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | A45892
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License Number State | CA
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