Provider Demographics
NPI:1063285377
Name:CHAMBERS, MICHAEL WAYNE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27069 ALMONDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6276
Mailing Address - Country:US
Mailing Address - Phone:714-865-9779
Mailing Address - Fax:
Practice Address - Street 1:4262 PARAMOUNT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2340
Practice Address - Country:US
Practice Address - Phone:714-865-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171400000XOther Service ProvidersHealth & Wellness Coach
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty