Healthcare Provider Details

I. General information

NPI: 1760856033
Provider Name (Legal Business Name): MS. CONNIE CHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 ALCAZAR ST CHP-133
LOS ANGELES CA
90089-0080
US

IV. Provider business mailing address

704 S SIERRA VISTA AVE APT D
ALHAMBRA CA
91801-4545
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-3550
  • Fax:
Mailing address:
  • Phone: 626-863-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2269
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: