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General NPI Number Information
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NPI Number | 1720120744
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Entity Type | Organization
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Legal Business Name | CHINO VALLEY FAMILY PHYSICIANS A MEDICAL GROUP
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 13193 CENTRAL AVE. SUITE 100
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City | CHINO
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State | CA
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Zip | 91710-3522
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Country | US
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Telephone | 909-464-9675
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Fax | 909-590-3898
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Provider Business Mailing Address
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Address Line | 13193 CENTRAL AVE. SUITE 100
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City | CHINO
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State | CA
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Zip | 91710-3522
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Country | US
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Telephone | 909-464-9675
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Fax | 909-590-3898
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SALLY HERNANDEZ
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Credential |
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Telephone | 909-464-9675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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