| Chino Hills Family Medical Group | |
|
15361 Central Ave Chino CA 91710-7608 | |
| (909) 393-7171 | |
| Not Available |
| Full Name | Chino Hills Family Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 15361 Central Ave, Chino, California |
| Authorized Official Name and Position | Cynthia Moreno (OWNER) |
| Authorized Official Contact | 9093937171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chino Hills Family Medical Group 15361 Central Ave Chino CA 91710-7608 Ph: (909) 393-7171 | Chino Hills Family Medical Group 15361 Central Ave Chino CA 91710-7608 Ph: (909) 393-7171 |
| NPI Number | 1043615610 |
|---|---|
| Provider Enumeration Date | 10/24/2014 |
| Last Update Date | 02/10/2020 |
| Medicare PECOS PAC ID | 1951625680 |
|---|---|
| Medicare Enrollment ID | O20150128001290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043615610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A8031 (California) | Primary |
| Provider Name | Cynthia D Moreno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053394817 PECOS PAC ID: 6305736117 Enrollment ID: I20040316001434 |
| Provider Name | Branka Vidic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164112942 PECOS PAC ID: 0042666596 Enrollment ID: I20231019002883 |
| Provider Name | Crystal Nicole Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902588726 PECOS PAC ID: 8022464213 Enrollment ID: I20231024003204 |
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