Healthcare Provider Details

I. General information

NPI: 1124681580
Provider Name (Legal Business Name): HEMALATHA MURUGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 9TH ST STE A
CHINO CA
91710-3528
US

IV. Provider business mailing address

12611 9TH ST STE A
CHINO CA
91710-3528
US

V. Phone/Fax

Practice location:
  • Phone: 909-331-4473
  • Fax: 909-331-4475
Mailing address:
  • Phone: 909-331-4473
  • Fax: 909-331-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA176363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: