MEDICARE: CHINO HILLS PODIATRY GROUP

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E4258	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	:	1689736944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINO HILLS PODIATRY GROUP

Provider Business Mailing Address
First Line	:	15944 LOS SERRANOS COUNTRY CLUB DR STE 130
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3254
Country	:	US
Telephone Number	:	909-287-0677
Fax Number	:	909-631-2919

Provider Business Practice Location Address
First Line	:	15944 LOS SERRANOS COUNTRY CLUB DR STE 130
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3254
Country	:	US
Telephone Number	:	909-287-0677
Fax Number	:	909-631-2919

Authorized Official
Title or Position	:	OWNER
Name	:	MS. VANESSA MARIE-LOUISE TAYLOR
Credential	:	DPM
Telephone Number	:	909-287-0677

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	04/11/2012

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Directions to “CHINO HILLS PODIATRY GROUP ” Practice Location

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