Healthcare Provider Details

I. General information

NPI: 1467452920
Provider Name (Legal Business Name): CHHAGAN VASOYA R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5096 CARTILLA AVE
ALTA LOMA CA
91737-1791
US

IV. Provider business mailing address

5096 CARTILLA AVE
ALTA LOMA CA
91737-1791
US

V. Phone/Fax

Practice location:
  • Phone: 909-980-6688
  • Fax: 909-398-1291
Mailing address:
  • Phone: 909-980-6688
  • Fax: 909-398-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: