MEDICARE: MAXCARE MEDICAL CENTER (CHUA) PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609383991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXCARE MEDICAL CENTER (CHUA) PLLC

Provider Business Mailing Address
First Line	:	6342 TOMAHAWK MILL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6342 TOMAHAWK MILL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7231
Country	:	US
Telephone Number	:	310-985-1753
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	EDNA GALINATO CHUA
Credential	:	APRN
Telephone Number	:	310-985-1753

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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