| Chapcare Lake Elizabeth | |
|
1595 N Lake Ave Pasadena CA 91104-2307 | |
| (626) 993-1262 | |
| (626) 486-9656 |
| Full Name | Chapcare Lake Elizabeth |
|---|---|
| Speciality | Clinic/Center |
| Location | 1595 N Lake Ave, Pasadena, California |
| Authorized Official Name and Position | Marcella Chavez (BOM) |
| Authorized Official Contact | 6269931238 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chapcare Lake Elizabeth 455 W Montana St Pasadena CA 91103-1327 Ph: (626) 993-1212 | Chapcare Lake Elizabeth 1595 N Lake Ave Pasadena CA 91104-2307 Ph: (626) 993-1262 |
| NPI Number | 1063748242 |
|---|---|
| Provider Enumeration Date | 10/23/2009 |
| Last Update Date | 06/19/2019 |
| Medicare PECOS PAC ID | 4789628512 |
|---|---|
| Medicare Enrollment ID | O20110317000617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063748242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550001311 (California) | Primary |
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