Basic Information
| Provider Information | |||||||||
| NPI: | 1891899068 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHORTKOFF | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12710 CARMEL COUNTRY ROAD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921302153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992708 | ||||||||
| FaxNumber: | 8584819755 | ||||||||
| Practice Location | |||||||||
| Address1: | 12710 CARMEL COUNTRY ROAD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921302153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992708 | ||||||||
| FaxNumber: | 8584819755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | G58820 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0G588200 | 05 | CA | MEDICAID |