Healthcare Provider Details

I. General information

NPI: 1275287351
Provider Name (Legal Business Name): LORENA E CHANES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 3 NUM 80 SUR
GUAYAMA PR
00784-1805
US

IV. Provider business mailing address

PO BOX 3190
GUAYAMA PR
00785-3190
US

V. Phone/Fax

Practice location:
  • Phone: 787-866-1212
  • Fax: 787-866-3322
Mailing address:
  • Phone: 787-358-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001174-PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: