Provider Demographics
NPI:1285737601
Name:CHENAL, MARIO EUGENIO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:EUGENIO
Last Name:CHENAL
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:PO BOX 9787
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0787
Mailing Address - Country:US
Mailing Address - Phone:509-575-8255
Mailing Address - Fax:509-225-3168
Practice Address - Street 1:808 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6388
Practice Address - Country:US
Practice Address - Phone:509-574-3400
Practice Address - Fax:509-574-3464
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040859207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8322257Medicaid
WA8322257Medicaid
WAAB29852Medicare PIN