MEDICARE: DR. TRACY MARIE CHAFFEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G70218	CA

General Provider Information

NPI Number	:	1063681633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY MARIE CHAFFEE M.D.

Provider Business Mailing Address
First Line	:	5347 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5357
Country	:	US
Telephone Number	:	562-434-3374
Fax Number	:

Provider Business Practice Location Address
First Line	:	5347 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5357
Country	:	US
Telephone Number	:	562-434-3374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	11/04/2021

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