Individual
IVAN TEODORO CHIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420-0160
(505) 368-6001
Mailing address
7345 WOODLAND DR STE C, INDIANAPOLIS, IN 46278-1737
(317) 286-2885
(317) 536-3097
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
718779
CA
163W00000X
Registered Nurse
Primary
RN-80640
NM
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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