Provider Demographics
NPI:1851699557
Name:INGALLA, ANTHONY CHIU
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CHIU
Last Name:INGALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14816 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-9509
Mailing Address - Country:US
Mailing Address - Phone:909-444-5797
Mailing Address - Fax:909-590-5203
Practice Address - Street 1:14816 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9509
Practice Address - Country:US
Practice Address - Phone:909-444-5797
Practice Address - Fax:909-590-5203
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01969FMedicaid
CA4129590001Medicare NSC