Provider Demographics
NPI:1255738241
Name:SOUTHERN CALIFORNIA PICC PROVIDERS, INC.
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA PICC PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:MARIA CATHERINE
Authorized Official - Middle Name:KOH
Authorized Official - Last Name:CHUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-945-9899
Mailing Address - Street 1:5787 LITTLE SHAY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4593
Mailing Address - Country:US
Mailing Address - Phone:909-251-7730
Mailing Address - Fax:909-251-7735
Practice Address - Street 1:5787 LITTLE SHAY DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336
Practice Address - Country:US
Practice Address - Phone:909-251-7730
Practice Address - Fax:909-251-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty