Healthcare Provider Details

I. General information

NPI: 1174103261
Provider Name (Legal Business Name): CHIARA MAE TOSOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E ALLEGHENY AVE
PHILADELPHIA PA
19134-3832
US

IV. Provider business mailing address

2055 E ALLEGHENY AVE
PHILADELPHIA PA
19134-3832
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95075722
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP030547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: