Provider Demographics
NPI:1265645568
Name:CHINCHILLA, SHEROL SUSSETTE (MS)
Entity Type:Individual
Prefix:
First Name:SHEROL
Middle Name:SUSSETTE
Last Name:CHINCHILLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAC USC MEDICAL CENTER
Mailing Address - Street 2:2010 ZONAL AVE., BLDG. OPD, RM. 2P70
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAC USC MEDICAL CENTER
Practice Address - Street 2:2010 ZONAL AVE., BLDG. OPD, RM. 2P70
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-5073
Practice Address - Fax:323-226-4417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2462231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist