Basic Information
| Provider Information | |||||||||
| NPI: | 1942892302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAPARRAL MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 TOWNE CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093981550 | ||||||||
| FaxNumber: | 9093981563 | ||||||||
| Practice Location | |||||||||
| Address1: | 9616 ARCHIBALD AVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917307944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093981550 | ||||||||
| FaxNumber: | 9093981563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2021 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | JEEREDDI | ||||||||
| AuthorizedOfficialFirstName: | PRASAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN / CEO | ||||||||
| AuthorizedOfficialTelephone: | 9093981550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.