Healthcare Provider Details

I. General information

NPI: 1619252939
Provider Name (Legal Business Name): CHAPARRAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12291 WASHINGTON BLVD SUITE 203
WHITTIER CA
90606-2500
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 562-693-6267
  • Fax: 562-693-6182
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: ADRIENNE WALKER
Title or Position: CONTRACTS MANAGER
Credential:
Phone: 909-398-1550