Provider Demographics
NPI:1154504561
Name:CHAPA, DINA Y
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:Y
Last Name:CHAPA
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-0669
Mailing Address - Country:US
Mailing Address - Phone:956-971-0848
Mailing Address - Fax:956-585-5260
Practice Address - Street 1:909 RAGLAND ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9243
Practice Address - Country:US
Practice Address - Phone:956-971-0848
Practice Address - Fax:956-585-5260
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082732332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010785601Medicaid
TX010785602Medicaid
TX010785601Medicaid