Provider Demographics
NPI:1265503247
Name:CHAVEZ, SHARISSE STRICAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARISSE
Middle Name:STRICAT
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARISSE
Other - Middle Name:A
Other - Last Name:STRICAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:3RD FLOOR PHR SYSTEMS
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:323-857-2000
Mailing Address - Fax:323-857-2000
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1702
Practice Address - Country:US
Practice Address - Phone:323-857-2000
Practice Address - Fax:310-419-3411
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G597150Medicaid
F12012Medicare UPIN