Healthcare Provider Details

I. General information

NPI: 1194506444
Provider Name (Legal Business Name): CLARISSA CHAVEZ CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 11/13/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 LONG BEACH BLVD
LONG BEACH CA
90806-1517
US

IV. Provider business mailing address

2933 LONG BEACH BLVD
LONG BEACH CA
90806-1517
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-2414
  • Fax:
Mailing address:
  • Phone: 562-988-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO05233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO05233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: