Provider Demographics
NPI:1225020803
Name:CHENNELL, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:CHENNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:225 E 2ND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4238
Mailing Address - Country:US
Mailing Address - Phone:760-738-9985
Mailing Address - Fax:760-738-0590
Practice Address - Street 1:225 E 2ND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4238
Practice Address - Country:US
Practice Address - Phone:760-738-9985
Practice Address - Fax:760-738-0590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG36959207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G369590Medicaid
A46884Medicare UPIN