Healthcare Provider Details

I. General information

NPI: 1114989241
Provider Name (Legal Business Name): CHAPARRAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 N ORANGE GROVE AVE CHAPARRAL MEDICAL GROUP
POMONA CA
91767-3008
US

IV. Provider business mailing address

840 TOWNE CENTER DR ADMINISTRATIVE RESOURCES
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-469-1823
  • Fax: 909-469-1827
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADRIENNE M WALKER
Title or Position: CONTRACTS ADMINISTRATOR
Credential:
Phone: 909-398-1550