Provider Demographics
NPI:1942012653
Name:TRUMBULL, CHANTELL LEA
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:LEA
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANTELL
Other - Middle Name:LEA
Other - Last Name:POINTER TRUMBULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4805 GOLDEN FOOTHILL PKWY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9651
Mailing Address - Country:US
Mailing Address - Phone:530-644-2412
Mailing Address - Fax:
Practice Address - Street 1:4805 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9651
Practice Address - Country:US
Practice Address - Phone:530-644-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator