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General NPI Number Information
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NPI Number | 1780260810
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Entity Type | Organization
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Legal Business Name | CHAPARRAL MEDICAL GROUP,INC.
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 550 INDIAN HILL BLVD.
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City | POMONA
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State | CA
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Zip | 91767-5378
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Country | US
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Telephone | 909-398-1550
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Fax | 909-398-0128
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Provider Business Mailing Address
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Address Line | 840 TOWNE CENTER DRIVE
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City | POMONA
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State | CA
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Zip | 91767
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Country | US
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Telephone | 909-398-1550
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Fax | 909-398-0128
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | PRASAD JEEREDDI
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Credential | M.D.
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Telephone | 909-398-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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