Provider Demographics
NPI:1235807041
Name:CHEKANOV, MINALOU MAY DIAMANTE (RDHAP)
Entity Type:Individual
Prefix:
First Name:MINALOU MAY
Middle Name:DIAMANTE
Last Name:CHEKANOV
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHWOOD DR APT 202
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4501
Mailing Address - Country:US
Mailing Address - Phone:510-962-0040
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHWOOD DR APT 202
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4501
Practice Address - Country:US
Practice Address - Phone:510-962-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2024-02-26
Deactivation Date:2021-09-06
Deactivation Code:
Reactivation Date:2024-02-21
Provider Licenses
StateLicense IDTaxonomies
CARDH28693124Q00000X
CAHAP751124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist