Provider Demographics
NPI:1437189180
Name:CHINO VALLEY MEDICAL GROUP
Entity Type:Organization
Organization Name:CHINO VALLEY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKAMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-8980
Mailing Address - Street 1:5450 JEFFERSON AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3522
Mailing Address - Country:US
Mailing Address - Phone:909-464-8980
Mailing Address - Fax:
Practice Address - Street 1:5450 JEFFERSON AVE
Practice Address - Street 2:STE 3
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3522
Practice Address - Country:US
Practice Address - Phone:909-464-8980
Practice Address - Fax:909-464-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty