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NPI Code Detail

MEDICARE: CHINO MEDICAL GROUP, INC

MEDICARE: CHINO 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
1207Q00000XFamily Medicine Physician
2207R00000XInternal Medicine Physician
32085R0202XDiagnostic Radiology Physician
4363A00000XPhysician Assistant
5363LF0000XFamily Nurse Practitioner
6302R00000XHealth Maintenance Organization

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790730786
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHINO MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 5475 WALNUT AVE
Second Line :
City : CHINO
State : CA
Zip : 91710-2609
Country : US
Telephone Number : 909-591-6446
Fax Number : 909-591-1309
Provider Business Practice Location Address
First Line : 5475 WALNUT AVE
Second Line :
City : CHINO
State : CA
Zip : 91710-2609
Country : US
Telephone Number : 909-591-6446
Fax Number : 909-591-1309
Authorized Official
Title or Position : CEO
Name : PRASAD JEEREDDI
Credential : MD
Telephone Number : 909-591-6446
Provider Enumeration Date : 05/24/2006
Last Update Date : 01/01/2025

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Practice Fax: 909-591-1309

Directions to “CHINO MEDICAL GROUP, INC ” Practice Location

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