Provider Demographics
NPI:1952652646
Name:SCOFIELD, CHANDRA D
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:D
Last Name:SCOFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHANDRA
Other - Middle Name:D
Other - Last Name:SCOFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:725 N SYCAMORE AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3301
Mailing Address - Country:US
Mailing Address - Phone:310-923-1314
Mailing Address - Fax:
Practice Address - Street 1:725 N SYCAMORE AVE APT 12
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3301
Practice Address - Country:US
Practice Address - Phone:310-923-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist