Provider Demographics
NPI:1174779193
Name:CAYO, CHANTAL JACQUELINE (ANP-BC)
Entity type:Individual
Prefix:MISS
First Name:CHANTAL
Middle Name:JACQUELINE
Last Name:CAYO
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S FIGUEROA ST APT 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2508
Mailing Address - Country:US
Mailing Address - Phone:914-323-8661
Mailing Address - Fax:
Practice Address - Street 1:222 S FIGUEROA ST APT 314
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012
Practice Address - Country:US
Practice Address - Phone:914-323-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-10
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584535163W00000X
CA95006266363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA584535OtherRN LICENSE
CA95006266OtherNP LICENSE