Provider Demographics
NPI:1265708572
Name:CHINO VALLEY MEDICAL CENTER
Entity type:Organization
Organization Name:CHINO VALLEY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:MIRAMONTES
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:909-590-7093
Mailing Address - Street 1:13152 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4048
Mailing Address - Country:US
Mailing Address - Phone:909-590-7093
Mailing Address - Fax:909-590-7621
Practice Address - Street 1:13152 MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4048
Practice Address - Country:US
Practice Address - Phone:909-590-7093
Practice Address - Fax:909-590-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17726261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care