MEDICARE: DANIEL M CHAVIRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A89310	CA

General Provider Information

NPI Number	:	1053358127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL M CHAVIRA MD

Provider Business Mailing Address
First Line	:	1609 GRANVIA ALTAMIRA
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2134
Country	:	US
Telephone Number	:	310-869-6840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 GRANVIA ALTAMIRA
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2134
Country	:	US
Telephone Number	:	310-869-6840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/18/2012

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