Provider Demographics
NPI:1619593324
Name:ABLANG, CHAD PANLILIO
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:PANLILIO
Last Name:ABLANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MAGNOLIA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1925
Mailing Address - Country:US
Mailing Address - Phone:650-580-8940
Mailing Address - Fax:
Practice Address - Street 1:950 MAGNOLIA AVE APT 4
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1925
Practice Address - Country:US
Practice Address - Phone:650-580-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool