Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G64892 | CA |
NPI | 1164557757 |
---|---|
Provider Name | Anna L Chavez |
First Address | Orange, CA 92868-3854 |
Second Address | Orange, CA 92868-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |