Provider Demographics
NPI:1770575102
Name:CHAUNCEY, CHRISTINA (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:CHAUNCEY
Suffix:
Gender:F
Credentials:DPM
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 20073
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-0073
Mailing Address - Country:US
Mailing Address - Phone:714-848-8998
Mailing Address - Fax:
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE # 352
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-848-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4246213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU79195Medicare UPIN
CAE4246Medicare ID - Type Unspecified
CAE4246AMedicare ID - Type Unspecified