Basic Information
| Provider Information | |||||||||
| NPI: | 1093753485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPLAND ANESTHESIA MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 148 | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917110148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852112 | ||||||||
| FaxNumber: | 9099853411 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099204848 | ||||||||
| FaxNumber: | 9099493970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 09/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHU | ||||||||
| AuthorizedOfficialFirstName: | CALEB | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9099852112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.