Healthcare Provider Details

I. General information

NPI: 1063135291
Provider Name (Legal Business Name): CHASE G LOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

4357 BAKMAN AVE
NORTH HOLLYWOOD CA
91602-2630
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3151
  • Fax:
Mailing address:
  • Phone: 818-397-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: