Southern California Picc Providers, Inc.

Primary specialty

Vascular Specialist/Technologist CardiovascularTaxonomy code 246XC2903X

Legal business name

SOUTHERN CALIFORNIA PICC PROVIDERS, INC.

Practice address

5787 Little Shay Dr
Fontana, CA 92336

Phone

(909) 251-7730

Fax

(909) 251-7735

NPI assigned

Nov 19, 2014

Last updated

Jul 13, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maria Catherine Koh Chua

Title

Member of the Board

Phone

(909) 945-9899

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531440000000",
    "number": "1255738241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5787 LITTLE SHAY DR",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923364593",
            "telephone_number": "909-251-7730",
            "fax_number": "909-251-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5787 LITTLE SHAY DR",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "92336",
            "telephone_number": "909-251-7730",
            "fax_number": "909-251-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PICC PROVIDERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2018-07-13",
        "status": "A",
        "authorized_official_last_name": "CHUA",
        "authorized_official_first_name": "MARIA CATHERINE",
        "authorized_official_middle_name": "KOH",
        "authorized_official_title_or_position": "MEMBER OF THE BOARD",
        "authorized_official_telephone_number": "909-945-9899"
    },
    "taxonomies": [
        {
            "code": "246XC2903X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist Cardiovascular, Vascular Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cardiovascular Specialist/Technologist in Fontana, CA
• Providers in Fontana, CA by specialty
• Cardiovascular Specialist/Technologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.