=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598782591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUIS A CHANES, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 02/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27871 MEDICAL CENTER RD SUITE 120
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-364-6688
-----------------------------------------------------
Fax | 949-364-6689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27871 MEDICAL CENTER RD SUITE 120
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-364-6688
-----------------------------------------------------
Fax | 949-364-6689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. LUIS ALBERTO CHANES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-364-6688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G73198
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------