Provider Demographics
NPI:1043567605
Name:CHAN, MABEL (RN)
Entity Type:Individual
Prefix:MISS
First Name:MABEL
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MABEL
Other - Middle Name:AHUVABATIA
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1138 S LA CIENEGA BLVD APT 15
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2541
Mailing Address - Country:US
Mailing Address - Phone:310-228-7605
Mailing Address - Fax:
Practice Address - Street 1:1138 S LA CIENEGA BLVD APT 15
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2541
Practice Address - Country:US
Practice Address - Phone:310-228-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA657171163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency