1730219379 NPI number — SANDRA ALICIA PINON-CHAVEZ M.S

Table of content: SANDRA ALICIA PINON-CHAVEZ M.S (NPI 1730219379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730219379 NPI number — SANDRA ALICIA PINON-CHAVEZ M.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINON-CHAVEZ
Provider First Name:
SANDRA
Provider Middle Name:
ALICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730219379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA HABRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90633-1132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-965-4463
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18780 AMAR RD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91789-4559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-965-4463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  46298 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC47630 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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