Healthcare Provider Details

I. General information

NPI: 1528642568
Provider Name (Legal Business Name): ANA CAROLINA RIOS CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 05/06/2022
Reactivation Date: 07/14/2022

III. Provider practice location address

1020 CRAFT RD STE A
ITHACA NY
14850-1016
US

IV. Provider business mailing address

333 CITY BLVD W STE 400
ORANGE CA
92868-2994
US

V. Phone/Fax

Practice location:
  • Phone: 607-339-0670
  • Fax:
Mailing address:
  • Phone: 714-456-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number34343601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: