Provider Demographics
NPI:1003955105
Name:CHUMLEY, NANOTCHKA M (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:NANOTCHKA
Middle Name:M
Last Name:CHUMLEY
Suffix:
Gender:F
Credentials:DO, MPH
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Mailing Address - Street 1:4859 W SLAUSON AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1290
Mailing Address - Country:US
Mailing Address - Phone:213-840-8949
Mailing Address - Fax:323-294-5514
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-808-2828
Practice Address - Fax:818-788-0386
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG88659Medicare UPIN