Provider Demographics
NPI:1235370826
Name:CHANDLER, DARLEEN MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:DARLEEN
Middle Name:MARIE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 ZONAL AVE.
Mailing Address - Street 2:ROOM 2P50
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-226-8105
Mailing Address - Fax:323-226-7701
Practice Address - Street 1:1020 ZONAL AVE.
Practice Address - Street 2:ROOM 2P50
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-8105
Practice Address - Fax:323-226-7701
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant