Healthcare Provider Details

I. General information

NPI: 1104416882
Provider Name (Legal Business Name): SAMAI CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 03/04/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 PHILADELPHIA ST
WHITTIER CA
90601-4302
US

IV. Provider business mailing address

1100 N STATE ST CLINIC TOWER A2E
LOS ANGELES CA
90033-5000
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0581
  • Fax:
Mailing address:
  • Phone: 323-409-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: