Provider Demographics
NPI:1518053289
Name:CHANCE, JANET MARY (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARY
Last Name:CHANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SUPERIOR AVE STE 200A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3663
Mailing Address - Country:US
Mailing Address - Phone:949-764-7363
Mailing Address - Fax:949-764-4624
Practice Address - Street 1:510 SUPERIOR AVE STE 200A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3663
Practice Address - Country:US
Practice Address - Phone:949-764-7363
Practice Address - Fax:949-764-4624
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-311262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-26360Medicare UPIN