Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 235900 | CA |
NPI | 1023537628 |
---|---|
Provider Name | Andrea Rebecca Chladek |
First Address | Palm Springs, CA 92262-5748 |
Second Address | Palm Springs, CA 92262-5748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 14/09/2017 |