Healthcare Provider Details

I. General information

NPI: 1093753485
Provider Name (Legal Business Name): UPLAND ANESTHESIA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

IV. Provider business mailing address

PO BOX 148
CLAREMONT CA
91711-0148
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-4848
  • Fax: 909-949-3970
Mailing address:
  • Phone: 909-985-2112
  • Fax: 909-985-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CALEB P. CHU
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 909-985-2112