=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891899068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA L CHORTKOFF M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 06/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12710 CARMEL COUNTRY ROAD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-499-2708
-----------------------------------------------------
Fax | 858-481-9755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12710 CARMEL COUNTRY ROAD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-499-2708
-----------------------------------------------------
Fax | 858-481-9755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | G58820
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------