Healthcare Provider Details

I. General information

NPI: 1366083099
Provider Name (Legal Business Name): LOREN RACHEL CHAN CPNP-PC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

5132 E LIVINGSTON DR APT 8
LONG BEACH CA
90803-5544
US

V. Phone/Fax

Practice location:
  • Phone: 562-270-3412
  • Fax:
Mailing address:
  • Phone: 650-515-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95011705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: