Provider Demographics
NPI:1134287196
Name:CHEZEM, CHELSEA MARIN (LPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIN
Last Name:CHEZEM
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MARIN
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:4845 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4313
Mailing Address - Country:US
Mailing Address - Phone:805-461-0900
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-781-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30507167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician