Healthcare Provider Details

I. General information

NPI: 1720785926
Provider Name (Legal Business Name): CHAPARRAL MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 H ST
BAKERSFIELD CA
93304-2909
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 213-497-3218
  • Fax:
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PRASAD A JEEREDDI
Title or Position: CEO
Credential: MD
Phone: 909-469-1823