Provider Demographics
NPI:1700597242
Name:CHEA, ERIC (LVN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CHEA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BACS, 390 40TH ST., OAKLAND, 94609
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-613-0330
Mailing Address - Fax:
Practice Address - Street 1:1421 BRODERICK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3304
Practice Address - Country:US
Practice Address - Phone:415-292-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA728052164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist