Healthcare Provider Details

I. General information

NPI: 1003217068
Provider Name (Legal Business Name): CHESA RICHMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHESA RICHMOND SLP-CCC

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HOSPITALITY LN STE 103
SAN BERNARDINO CA
92408-3238
US

IV. Provider business mailing address

11660 CHURCH ST APT 492
RANCHO CUCAMONGA CA
91730-8945
US

V. Phone/Fax

Practice location:
  • Phone: 909-567-2221
  • Fax: 909-763-3216
Mailing address:
  • Phone: 202-247-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: