Provider Demographics
NPI:1215974969
Name:CHAVEZ, BRIAN ESCALA (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ESCALA
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23331 EL TORO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4891
Mailing Address - Country:US
Mailing Address - Phone:949-916-9100
Mailing Address - Fax:949-916-0091
Practice Address - Street 1:23331 EL TORO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4891
Practice Address - Country:US
Practice Address - Phone:949-916-9100
Practice Address - Fax:949-916-0091
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76077207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI03191Medicare UPIN
CAWA76077DMedicare PIN