Provider Demographics
NPI:1215599337
Name:CHAMLATI, RACHA
Entity type:Individual
Prefix:
First Name:RACHA
Middle Name:
Last Name:CHAMLATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E CHAPMAN AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3108
Mailing Address - Country:US
Mailing Address - Phone:714-706-0206
Mailing Address - Fax:949-258-3742
Practice Address - Street 1:2501 E CHAPMAN AVE STE 265
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3108
Practice Address - Country:US
Practice Address - Phone:714-706-0206
Practice Address - Fax:949-258-3742
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1824142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry