=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316165384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CESAR CHAVARRIA, MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18425 BURBANK BLVD SUITE 719
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-357-5732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17613
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91416-7613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-362-2455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE MANAGER
-----------------------------------------------------
Name | KAREN HALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-357-5732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0214X
-----------------------------------------------------
Taxonomy Name | Pediatric Pulmonology Physician
-----------------------------------------------------
License Number | A43308
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------