Provider Demographics
NPI:1649389545
Name:NEIL I. CHAFETZ, M.D. INC
Entity Type:Organization
Organization Name:NEIL I. CHAFETZ, M.D. INC
Other - Org Name:ORACLE IMAGING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:CHAFETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, RADIOLOGY
Authorized Official - Phone:310-833-2233
Mailing Address - Street 1:1360 W 6TH ST
Mailing Address - Street 2:WEST BLDG. - SUITE 100
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-833-2233
Mailing Address - Fax:310-833-2213
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:WEST BLDG. - SUITE 100
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-833-2233
Practice Address - Fax:310-833-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G295042Medicaid
CAA44058Medicare UPIN
CA300053916Medicare ID - Type UnspecifiedRR MEDICARE
CA00G295042Medicaid