Provider Demographics
NPI:1851395131
Name:CHAPA, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CHAPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 E MORADA LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2410
Mailing Address - Country:US
Mailing Address - Phone:209-601-8881
Mailing Address - Fax:209-931-4850
Practice Address - Street 1:5040 E MORADA LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212
Practice Address - Country:US
Practice Address - Phone:209-601-8881
Practice Address - Fax:209-931-4850
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G337471Medicaid
756083107OtherRAILROAD MEDICARE
A45666Medicare UPIN
CA00G337471Medicaid