MEDICARE: ANTHONY C INGALLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	31063	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003883059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY C INGALLA

Provider Business Mailing Address
First Line	:	14816 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-9509
Country	:	US
Telephone Number	:	888-964-9475
Fax Number	:	888-747-9645

Provider Business Practice Location Address
First Line	:	14816 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-9509
Country	:	US
Telephone Number	:	888-964-9475
Fax Number	:	888-747-9645

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY C INGALLA
Credential	:
Telephone Number	:	888-964-9475

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	04/04/2008

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