Provider Demographics
NPI:1740759638
Name:CHAMBERS, ANICETO B III
Entity Type:Individual
Prefix:MR
First Name:ANICETO
Middle Name:B
Last Name:CHAMBERS
Suffix:III
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 1:11055 CANDOR ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6427
Mailing Address - Country:US
Mailing Address - Phone:562-650-7139
Mailing Address - Fax:
Practice Address - Street 1:2515 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90810-1519
Practice Address - Country:US
Practice Address - Phone:310-830-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse