Healthcare Provider Details

I. General information

NPI: 1558464107
Provider Name (Legal Business Name): CRISPINA ANCHETA CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
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: 626-452-0268
Mailing address:
  • Phone: 626-443-8918
  • Fax: 626-452-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: