Provider Demographics
NPI:1194879163
Name:CHAVEZ, DARIO MATANGUIHAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DARIO
Middle Name:MATANGUIHAN
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 TALISMAN ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1460
Mailing Address - Country:US
Mailing Address - Phone:310-214-1067
Mailing Address - Fax:
Practice Address - Street 1:373 VAN NESS AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-6244
Practice Address - Country:US
Practice Address - Phone:310-320-6765
Practice Address - Fax:310-320-6683
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 39315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist