Healthcare Provider Details

I. General information

NPI: 1962478768
Provider Name (Legal Business Name): MAURICE GERARD CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTNGALE ROAD
EDWARDS CA
93524-0001
US

IV. Provider business mailing address

4218 VAHAN CT
LANCASTER CA
93536-6861
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-7118
  • Fax:
Mailing address:
  • Phone: 661-943-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number63842
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: