| Tiffany Anderson Terrell, Do. Inc | |
|
5253 Riverside Dr Chino CA 91710-4151 | |
| (909) 464-2845 | |
| (909) 464-2848 |
| Full Name | Tiffany Anderson Terrell, Do. Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5253 Riverside Dr, Chino, California |
| Authorized Official Name and Position | Tiffany Anderson Terrell (PRESIDENT/OWNER) |
| Authorized Official Contact | 9095484900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tiffany Anderson Terrell, Do. Inc 13193 Central Ave Suite 210 Chino CA 91710-4179 Ph: (909) 548-4900 | Tiffany Anderson Terrell, Do. Inc 5253 Riverside Dr Chino CA 91710-4151 Ph: (909) 464-2845 |
| NPI Number | 1053638601 |
|---|---|
| Provider Enumeration Date | 04/22/2010 |
| Last Update Date | 11/09/2010 |
| Medicare PECOS PAC ID | 0345371282 |
|---|---|
| Medicare Enrollment ID | O20100622000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053638601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 20A8506 (California) | Primary |
| Provider Name | Tiffany L Anderson Terrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629188404 PECOS PAC ID: 6901853662 Enrollment ID: I20050405000453 |
| Provider Name | Jennifer Anne Hagler Buckley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174179113 PECOS PAC ID: 9133551369 Enrollment ID: I20191108002550 |
| Provider Name | Cameon Adonna Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275291924 PECOS PAC ID: 1052793494 Enrollment ID: I20221205002862 |
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