Provider Demographics
NPI:1689881039
Name:PENTA, CHAKRADHAR (MD, BS)
Entity Type:Individual
Prefix:DR
First Name:CHAKRADHAR
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Last Name:PENTA
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Gender:M
Credentials:MD, BS
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Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:MOB 2 - PHYSICAL MEDICINE
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-3945
Mailing Address - Fax:909-427-5282
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:MOB 2 - PHYSICAL MEDICINE
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-3945
Practice Address - Fax:909-427-5282
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
CAA98881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation