Healthcare Provider Details

I. General information

NPI: 1053358127
Provider Name (Legal Business Name): DANIEL M CHAVIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 GRANVIA ALTAMIRA
PALOS VERDES ESTATES CA
90274-2134
US

IV. Provider business mailing address

1609 GRANVIA ALTAMIRA
PALOS VERDES ESTATES CA
90274-2134
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-6840
  • Fax:
Mailing address:
  • Phone: 310-869-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA89310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: