Provider Demographics
NPI:1609383991
Name:MAXCARE MEDICAL CENTER (CHUA) PLLC
Entity Type:Organization
Organization Name:MAXCARE MEDICAL CENTER (CHUA) PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:GALINATO
Authorized Official - Last Name:CHUA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:310-985-1753
Mailing Address - Street 1:6342 TOMAHAWK MILL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6342 TOMAHAWK MILL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7231
Practice Address - Country:US
Practice Address - Phone:310-985-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty