Provider Demographics
NPI:1205870565
Name:CHAMBI, ISRAEL PEDRO (MD)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:PEDRO
Last Name:CHAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S MONTGOMERY WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3500
Mailing Address - Country:US
Mailing Address - Phone:714-973-0810
Mailing Address - Fax:714-973-0840
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-973-0810
Practice Address - Fax:714-973-0840
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34163174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341630Medicaid
CA00A341630Medicaid