Provider Demographics
NPI:1972701274
Name:CHAKHOYAN, MARINE
Entity Type:Individual
Prefix:MRS
First Name:MARINE
Middle Name:
Last Name:CHAKHOYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARINE
Other - Middle Name:
Other - Last Name:CHAKHOYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2236 RHODA WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2029
Mailing Address - Country:US
Mailing Address - Phone:916-857-0817
Mailing Address - Fax:916-857-0816
Practice Address - Street 1:2236 RHODA WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2029
Practice Address - Country:US
Practice Address - Phone:916-857-0817
Practice Address - Fax:916-857-0816
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6007450001332BC3200X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6007450001Medicare NSC