MEDICARE: CHAPARRAL MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	C40547	CA

General Provider Information

NPI Number	:	1134508955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPARRAL MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DR
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1573

Provider Business Practice Location Address
First Line	:	297 W ARTESIA ST
Second Line	:	SUITE A
City	:	POMONA
State	:	CA
Zip	:	91768-1808
Country	:	US
Telephone Number	:	909-623-1503
Fax Number	:	909-623-8061

Authorized Official
Title or Position	:	CONTRACTS MANAGER
Name	:	ADRIENNE WALKER
Credential	:
Telephone Number	:	909-398-1550

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	05/26/2015

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