MEDICARE: CHAPARRAL MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1851453757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPARRAL MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DRIVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1573

Provider Business Practice Location Address
First Line	:	2140 GRAND AVENUE
Second Line	:	SUITE #210
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6801
Country	:	US
Telephone Number	:	909-623-8796
Fax Number	:	909-623-3076

Authorized Official
Title or Position	:	CONTRACTS ADMINISTRATOR
Name	:	MRS. ADRIENNE M WALKER
Credential	:
Telephone Number	:	909-398-1550

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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