Provider Demographics
NPI:1609803212
Name:CHAVARRIA, CESAR (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:CHAVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18880 PASADERO DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18425 BURBANK BLVD
Practice Address - Street 2:SUITE 719
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2806
Practice Address - Country:US
Practice Address - Phone:818-342-0793
Practice Address - Fax:818-342-0794
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA433082080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433080Medicaid
CAA43308Medicare ID - Type Unspecified
CA00A433080Medicaid