Healthcare Provider Details

I. General information

NPI: 1598528945
Provider Name (Legal Business Name): CHICHIHUALTIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14621 VAN NUYS PL
PANORAMA CITY CA
91402-1024
US

IV. Provider business mailing address

14621 VAN NUYS PL
PANORAMA CITY CA
91402-1024
US

V. Phone/Fax

Practice location:
  • Phone: 818-747-4294
  • Fax:
Mailing address:
  • Phone: 818-747-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: GUSTAVO GONZALEZ
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 818-747-4294