Healthcare Provider Details

I. General information

NPI: 1922178029
Provider Name (Legal Business Name): GERALD CHATMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD SUITE 204
LOS ANGELES CA
90036-4667
US

IV. Provider business mailing address

6815 NOBLE AVE SUITE 105
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-2300
  • Fax: 323-938-2330
Mailing address:
  • Phone: 323-938-2300
  • Fax: 323-938-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: