Provider Demographics
NPI:1033108246
Name:CHABALA, JAMES V (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:CHABALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNSITE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5566
Mailing Address - Country:US
Mailing Address - Phone:760-630-2422
Mailing Address - Fax:
Practice Address - Street 1:840 TOWNSITE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5566
Practice Address - Country:US
Practice Address - Phone:760-630-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44746Medicare UPIN
CAW11117Medicare ID - Type Unspecified