MEDICARE: LUIS A CHANES M D INC

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	174400000X	Specialist	G73198	CA

General Provider Information

NPI Number	:	1568481679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUIS A CHANES M D INC

Provider Business Mailing Address
First Line	:	2621 S BRISTOL ST
Second Line	:	SUITE 205
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5766
Country	:	US
Telephone Number	:	714-557-5777
Fax Number	:	714-557-7710

Provider Business Practice Location Address
First Line	:	2621 S BRISTOL ST
Second Line	:	SUITE 205
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5766
Country	:	US
Telephone Number	:	714-557-5777
Fax Number	:	714-557-7710

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. LUIS ALBERTO CHANES
Credential	:	M.D.
Telephone Number	:	714-557-5777

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	01/18/2022

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