Provider Demographics
NPI:1295143972
Name:HARITHA R CHELIMILLA MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HARITHA R CHELIMILLA MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARITHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHELIMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-436-3535
Mailing Address - Street 1:2224 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2224 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2638
Practice Address - Country:US
Practice Address - Phone:951-436-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124727207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty