MEDICARE: CLAUDIA GRANDE CHAVEZ

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	163W00000X	Registered Nurse	95033669	CA
2	363L00000X	Nurse Practitioner	95020039	CA

General Provider Information

NPI Number	:	1669127775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA GRANDE CHAVEZ

Provider Business Mailing Address
First Line	:	822 N NANTES AVE
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-2700
Country	:	US
Telephone Number	:	323-541-7967
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 LAUREL AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2316
Country	:	US
Telephone Number	:	310-795-8807
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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Directions to “ CLAUDIA GRANDE CHAVEZ ” Practice Location

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