Healthcare Provider Details

I. General information

NPI: 1780146019
Provider Name (Legal Business Name): CHAPARRAL MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E. 11TH STREET #208 & #207
UPLAND CA
91786-4872
US

IV. Provider business mailing address

840 TOWNE CENTER DRIVE
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-629-5540
  • Fax: 909-946-3070
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: PRASAD A JEEREDDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-398-1550