Healthcare Provider Details

I. General information

NPI: 1245552587
Provider Name (Legal Business Name): CRISPINA A. CHEN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10802 RAMONA BLVD
EL MONTE CA
91731-2628
US

IV. Provider business mailing address

10802 RAMONA BLVD
EL MONTE CA
91731-2628
US

V. Phone/Fax

Practice location:
  • Phone: 626-443-8918
  • Fax:
Mailing address:
  • Phone: 626-443-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36095
License Number StateCA

VIII. Authorized Official

Name: DR. CRISPINA A. CHEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-443-8918