1750634325 NPI number — CHAPARRAL MEDICAL GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750634325 NPI number — CHAPARRAL MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAPARRAL MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750634325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 CHINO AVENUE
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
CHINO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91709-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-465-9266
Provider Business Practice Location Address Fax Number:
909-465-9220
Provider Enumeration Date:
10/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
ADRIENNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTS MANAGER
Authorized Official Telephone Number:
909-398-1550

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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