MEDICARE: CHAKA DESOUZA B.S.N. R.N.

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	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1538597620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAKA DESOUZA B.S.N. R.N.

Provider Business Mailing Address
First Line	:	8001 TIN CUP DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-6104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 TIN CUP DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-6104
Country	:	US
Telephone Number	:	469-964-2279
Fax Number	:

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

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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Directions to “ CHAKA DESOUZA B.S.N. R.N.” Practice Location

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