Provider Demographics
NPI:1558464107
Name:CHEN, CRISPINA ANCHETA (MD)
Entity Type:Individual
Prefix:
First Name:CRISPINA
Middle Name:ANCHETA
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2628
Mailing Address - Country:US
Mailing Address - Phone:626-443-8918
Mailing Address - Fax:626-452-0268
Practice Address - Street 1:10802 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2628
Practice Address - Country:US
Practice Address - Phone:626-443-8918
Practice Address - Fax:626-452-0268
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A360951Medicare ID - Type Unspecified
A84857Medicare UPIN