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General NPI Number Information
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NPI Number | 1699396754
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH ELEVATED MEDICAL CORP
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Dates
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Enumeration Date | 04/29/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 17026 DEVONSHIRE ST
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1617
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Country | US
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Telephone | 818-488-9638
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Fax | 818-875-3228
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Provider Business Mailing Address
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Address Line | 17026 DEVONSHIRE ST
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1617
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Country | US
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Telephone | 818-488-9638
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Fax | 818-875-3228
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANOTCHKA CHUNLEY
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Credential | DO
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Telephone | 310-598-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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