Provider Demographics
NPI:1114290087
Name:CHEVALIER, LASHAWN THERESA
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:THERESA
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E. HILLCREST BL
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2423
Mailing Address - Country:US
Mailing Address - Phone:310-680-7889
Mailing Address - Fax:310-680-7882
Practice Address - Street 1:314 E. HILLCREST BL
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2423
Practice Address - Country:US
Practice Address - Phone:310-680-7889
Practice Address - Fax:310-680-7882
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101260332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies