Healthcare Provider Details

I. General information

NPI: 1265144877
Provider Name (Legal Business Name): LEGADO CHAFINO & CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4959 PALO VERDE ST STE 103A-5
MONTCLAIR CA
91763-2338
US

IV. Provider business mailing address

4959 PALO VERDE ST STE 103A-5
MONTCLAIR CA
91763-2338
US

V. Phone/Fax

Practice location:
  • Phone: 909-779-9160
  • Fax: 909-245-2808
Mailing address:
  • Phone: 909-779-9160
  • Fax: 909-245-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN SERGIO CHAFINO
Title or Position: PRESIDENT
Credential:
Phone: 909-779-9160