Provider Demographics
NPI:1740843812
Name:CHUMACERO-ROJAS, EHECATL
Entity type:Individual
Prefix:
First Name:EHECATL
Middle Name:
Last Name:CHUMACERO-ROJAS
Suffix:
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 1:1719 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5704
Mailing Address - Country:US
Mailing Address - Phone:323-467-8466
Mailing Address - Fax:
Practice Address - Street 1:1719 TAFT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5704
Practice Address - Country:US
Practice Address - Phone:323-467-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator