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13751 Roswell Ave Suite A Chino CA 91710-5464 | |
| (909) 591-4033 | |
| (909) 902-6055 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 13751 Roswell Ave, Chino, California |
| Authorized Official Name and Position | Maureen Antoinette Burney (OWNER) |
| Authorized Official Contact | 9095914033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
13751 Roswell Ave Suite A Chino CA 91710-5464 Ph: (909) 591-4033 | 13751 Roswell Ave Suite A Chino CA 91710-5464 Ph: (909) 591-4033 |
| NPI Number | 1063639623 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 10/21/2011 |
| Medicare PECOS PAC ID | 0941471783 |
|---|---|
| Medicare Enrollment ID | O20110927000598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063639623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY12728 (California) | Primary |
| Provider Name | Maureen A Burney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487722989 PECOS PAC ID: 6305019928 Enrollment ID: I20111026000936 |
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