Healthcare Provider Details

I. General information

NPI: 1699396754
Provider Name (Legal Business Name): TOTAL HEALTH ELEVATED MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17022 DEVONSHIRE ST
NORTHRIDGE CA
91325-1617
US

IV. Provider business mailing address

17022 DEVONSHIRE ST
NORTHRIDGE CA
91325-1617
US

V. Phone/Fax

Practice location:
  • Phone: 818-923-5405
  • Fax: 818-875-3228
Mailing address:
  • Phone: 818-923-5405
  • Fax: 818-875-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NANOTCHKA CHUNLEY
Title or Position: OWNER
Credential: DO
Phone: 310-598-6020