Healthcare Provider Details

I. General information

NPI: 1316104508
Provider Name (Legal Business Name): MARSHNEIL CHAVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD STE 102
IRVINE CA
92618-2126
US

IV. Provider business mailing address

15825 LAGUNA CANYON RD STE 102
IRVINE CA
92618-2126
US

V. Phone/Fax

Practice location:
  • Phone: 949-733-2800
  • Fax:
Mailing address:
  • Phone: 713-826-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP0563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: