Provider Demographics
NPI:1770798902
Name:CHODAKIEWITZ, ESTHER LIBA (MD QME)
Entity type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:LIBA
Last Name:CHODAKIEWITZ
Suffix:
Gender:F
Credentials:MD QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7202
Mailing Address - Country:US
Mailing Address - Phone:909-364-9994
Mailing Address - Fax:909-364-9322
Practice Address - Street 1:11800 CENTRAL AVE
Practice Address - Street 2:#125
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-364-9994
Practice Address - Fax:909-364-9322
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA491292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF43942Medicare ID - Type Unspecified