Provider Demographics
NPI:1952416604
Name:MOJICA, CHESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:
Last Name:MOJICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5489 E SUNCREST RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3743
Mailing Address - Country:US
Mailing Address - Phone:714-283-3507
Mailing Address - Fax:714-279-0883
Practice Address - Street 1:431 N TUSTIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3821
Practice Address - Country:US
Practice Address - Phone:714-558-1124
Practice Address - Fax:714-558-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF80598Medicare UPIN