Provider Demographics
NPI:1336117738
Name:PRADHAN, RITA KAMAL (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KAMAL
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
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 1:1904 N ORANGE GROVE AVE
Practice Address - Street 2:CHAPARRAL MEDICAL GROUP
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3008
Practice Address - Country:US
Practice Address - Phone:909-469-1823
Practice Address - Fax:909-469-1827
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63665207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636650Medicaid
H59465Medicare UPIN
CA00A636650Medicaid