Provider Demographics
NPI:1821373978
Name:CHINO VALLEY ORTHOPEDIC CENTER INC
Entity Type:Organization
Organization Name:CHINO VALLEY ORTHOPEDIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:909-464-9675
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:SUITE K 209
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-340-1003
Mailing Address - Fax:760-340-4844
Practice Address - Street 1:13193 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4179
Practice Address - Country:US
Practice Address - Phone:909-464-9675
Practice Address - Fax:909-590-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6681380001Medicare NSC