Organization
CHINO MEDICAL GROUP, INC
Active
Other names
My Family Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
PRASAD JEEREDDI MD (CEO)
(909) 591-6446
Entity
Organization
Contact information
Practice address
5475 WALNUT AVE, CHINO, CA 91710-2609
(909) 591-6446
(909) 591-1309
Mailing address
5475 WALNUT AVE, CHINO, CA 91710-2609
(909) 591-6446
(909) 591-1309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059290
—
CA
Enumeration date
05/24/2006
Last updated
01/01/2025
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