Healthcare Provider Details

I. General information

NPI: 1508669797
Provider Name (Legal Business Name): CHANTALLE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE STE 330
NEWPORT BEACH CA
92663-3658
US

IV. Provider business mailing address

25427 BOXELDER DR
MURRIETA CA
92563-5334
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-2800
  • Fax: 949-646-8147
Mailing address:
  • Phone: 951-219-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA67514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: