Provider Demographics
NPI:1326601345
Name:CHASE, SHONDA
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22330 HAWTHORNE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2551
Mailing Address - Country:US
Mailing Address - Phone:310-420-3611
Mailing Address - Fax:310-414-0777
Practice Address - Street 1:22330 HAWTHORNE BLVD STE J
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2551
Practice Address - Country:US
Practice Address - Phone:310-375-7599
Practice Address - Fax:310-414-0777
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily