Provider Demographics
NPI:1831367028
Name:MARINE CHAKHOYAN
Entity type:Organization
Organization Name:MARINE CHAKHOYAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKHOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-857-0817
Mailing Address - Street 1:3366 MATHER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5966
Mailing Address - Country:US
Mailing Address - Phone:916-587-0817
Mailing Address - Fax:916-857-0816
Practice Address - Street 1:3366 MATHER FIELD RD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5966
Practice Address - Country:US
Practice Address - Phone:916-587-0817
Practice Address - Fax:916-857-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101973332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6007450001Medicare NSC