Healthcare Provider Details

I. General information

NPI: 1831785468
Provider Name (Legal Business Name): ALEC CHANDLER MANUEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 812
WEST HOLLYWOOD CA
90069-3709
US

IV. Provider business mailing address

1031 N CRESCENT HEIGHTS BLVD APT 1F
WEST HOLLYWOOD CA
90046-6065
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-1010
  • Fax:
Mailing address:
  • Phone: 859-321-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: