Provider Demographics
NPI:1639197411
Name:CHAZAN, ELLA F
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:F
Last Name:CHAZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21658 CLUB VILLA TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3701
Mailing Address - Country:US
Mailing Address - Phone:561-338-3001
Mailing Address - Fax:561-447-6578
Practice Address - Street 1:21658 CLUB VILLA TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3701
Practice Address - Country:US
Practice Address - Phone:561-338-3001
Practice Address - Fax:561-447-6578
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC0004044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9520OtherBC/BS PROVIDER ID