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General NPI Number Information
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NPI Number | 1053350884
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Entity Type | Organization
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Legal Business Name | CHINO MEDICAL GROUP, INC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 5475 WALNUT AVE
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City | CHINO
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State | CA
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Zip | 91710-2609
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Country | US
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Telephone | 909-591-6446
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Fax | 909-591-1309
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Provider Business Mailing Address
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Address Line | 5475 WALNUT AVE
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City | CHINO
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State | CA
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Zip | 91710-2609
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Country | US
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Telephone | 909-591-6446
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Fax | 909-591-1309
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Authorized Official
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Title or Position | CEO
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Name | PRASAD JEEREDDI
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Credential | MD
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Telephone | 909-591-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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