Provider Demographics
NPI:1922074608
Name:MEDICAL GROUP OF CHINO HILLS, INC
Entity Type:Organization
Organization Name:MEDICAL GROUP OF CHINO HILLS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-902-9998
Mailing Address - Street 1:3233 GRAND AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1489
Mailing Address - Country:US
Mailing Address - Phone:909-902-9998
Mailing Address - Fax:909-902-0995
Practice Address - Street 1:3233 GRAND AVE
Practice Address - Street 2:SUITE H
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1489
Practice Address - Country:US
Practice Address - Phone:909-902-9998
Practice Address - Fax:909-902-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43068207Q00000X
CAA50414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083560Medicaid
CAZZZ58731ZOtherBLUE SHIELD #
CA=========OtherFEDERAL TAX ID