Provider Demographics
NPI:1689736944
Name:CHINO HILLS PODIATRY GROUP
Entity Type:Organization
Organization Name:CHINO HILLS PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARIE-LOUISE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:909-287-0677
Mailing Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3254
Mailing Address - Country:US
Mailing Address - Phone:909-287-0677
Mailing Address - Fax:909-631-2919
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 130
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3254
Practice Address - Country:US
Practice Address - Phone:909-287-0677
Practice Address - Fax:909-631-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4258213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42580Medicaid
CA000E42580Medicaid
CAZZZ29187ZMedicare ID - Type UnspecifiedGROUP NUMBER