MEDICARE: MR. ANTHONY CHIU 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

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	:	1851699557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY CHIU INGALLA

Provider Business Mailing Address
First Line	:	14816 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-9509
Country	:	US
Telephone Number	:	909-444-5797
Fax Number	:	909-590-5203

Provider Business Practice Location Address
First Line	:	14816 CENTRAL AVE
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-9509
Country	:	US
Telephone Number	:	909-444-5797
Fax Number	:	909-590-5203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/04/2011

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