Healthcare Provider Details

I. General information

NPI: 1740066125
Provider Name (Legal Business Name): NATHALY MILAGRO CHINCHAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N ORANGE GROVE BLVD
PASADENA CA
91103-3333
US

IV. Provider business mailing address

855 N ORANGE GROVE BLVD STE 207
PASADENA CA
91103-3333
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax: 626-296-8910
Mailing address:
  • Phone: 626-296-8900
  • Fax: 626-296-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: