Provider Demographics
NPI:1518001114
Name:MAPARA MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MAPARA MEDICAL GROUP, INC
Other - Org Name:SUNRISE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KALPNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-970-0911
Mailing Address - Street 1:5475 E. LA PALMA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:714-970-0911
Mailing Address - Fax:714-970-0604
Practice Address - Street 1:5475 E. LA PALMA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:714-970-0911
Practice Address - Fax:714-970-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28448207Q00000X
CAA37744207Q00000X
CAA78248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37744OtherSTATE LICENSE
CAZZZ180367OtherBLUE SHIELD PIN
CAZZZ180367OtherBLUE SHIELD PIN