Provider Demographics
NPI:1194206847
Name:VALDIVIA, CHAU (OD)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 S ANAHEIM BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5591
Mailing Address - Country:US
Mailing Address - Phone:714-491-0881
Mailing Address - Fax:
Practice Address - Street 1:947 S ANAHEIM BLVD STE 230
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5591
Practice Address - Country:US
Practice Address - Phone:714-491-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34289TLG152W00000X
NV990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherN/A