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General NPI Number Information
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NPI Number | 1770843112
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Entity Type | Individual
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Provider Name | MR. JEFFREY DULAY CHAN
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Gender | Male
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1605 SCOTT AVE STE 400
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City | EL CENTRO
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State | CA
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Zip | 92243-1790
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Country | US
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Telephone | 760-352-3108
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Fax | 760-352-3234
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Provider Business Mailing Address
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Address Line | 1450 S IMPERIAL AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-4200
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Country | US
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Telephone | 760-352-3108
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Fax | 760-352-3234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95018570
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018570
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 698955
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License Number State | CA
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