Healthcare Provider Details

I. General information

NPI: 1619900750
Provider Name (Legal Business Name): CHANDRAHAS AGARWAL M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8287 WHITE OAK AVE
RANCHO CUCAMONGA CA
91730-7671
US

IV. Provider business mailing address

8287 WHITE OAK AVE
RANCHO CUCAMONGA CA
91730-7671
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-0808
  • Fax: 909-476-0811
Mailing address:
  • Phone: 909-476-0808
  • Fax: 909-476-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA43186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA43186
License Number StateCA

VIII. Authorized Official

Name: CHANDRAHAS AGARWAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-620-0900