Healthcare Provider Details

I. General information

NPI: 1356437586
Provider Name (Legal Business Name): CHELSEY OVERSTREET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 MONTE VISTA ST
PASADENA CA
91106-1310
US

IV. Provider business mailing address

1662 MONTE VISTA ST
PASADENA CA
91106-1310
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-6714
  • Fax: 626-796-6714
Mailing address:
  • Phone: 626-796-6714
  • Fax: 626-796-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberA76777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: