Provider Demographics
NPI:1235695289
Name:CHAPARRAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHAPARRAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEEREDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-398-1550
Mailing Address - Street 1:840 TOWNE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:1880 N ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3006
Practice Address - Country:US
Practice Address - Phone:909-620-7200
Practice Address - Fax:909-620-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty