MEDICARE: DR. MARK CHOFLA D.O.

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	2084P0800X	Psychiatry Physician	20A8365	CA

General Provider Information

NPI Number	:	1447338934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK CHOFLA D.O.

Provider Business Mailing Address
First Line	:	5960 S LAND PARK DR
Second Line	:	#326
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-3313
Country	:	US
Telephone Number	:	916-760-8197
Fax Number	:	888-661-6285

Provider Business Practice Location Address
First Line	:	1909 CAPITOL AVE
Second Line	:	#100
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-4235
Country	:	US
Telephone Number	:	916-760-8197
Fax Number	:	888-661-6285

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/30/2012

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