Basic Information
| Provider Information | |||||||||
| NPI: | 1316175466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIVABUNDITT | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | WATCHARA | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2611 E WALL ST | ||||||||
| Address2: | |||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907551137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098595327 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1078 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908133403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622850149 | ||||||||
| FaxNumber: | 5622850156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 07/07/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | NA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.