Healthcare Provider Details

I. General information

NPI: 1205898335
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: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 NORTH MOUNTAIN AVE SUITE A
UPLAND CA
91786-8516
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 909-946-2228
  • Fax: 909-946-8007
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

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