MEDICARE: MRS. STEPHANIE A CHAMANI PA-C

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	363A00000X	Physician Assistant	PA16024	CA

General Provider Information

NPI Number	:	1104949858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE A CHAMANI PA-C

Provider Business Mailing Address
First Line	:	14740 PIPELINE AVE STE D
Second Line	:	SUITE D
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1293
Country	:	US
Telephone Number	:	909-393-3005
Fax Number	:	909-393-3006

Provider Business Practice Location Address
First Line	:	14740 PIPELINE AVE STE D
Second Line	:	SUITE D
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1293
Country	:	US
Telephone Number	:	909-393-3005
Fax Number	:	909-393-3006

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/17/2014

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