Basic Information
| Provider Information | |||||||||
| NPI: | 1437480019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | DELYSSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5275 MARKET ST # G | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921142212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192637090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5275 MARKET ST # G | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921142212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192637090 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 744202 | CA | Y | Nursing Service Providers | Registered Nurse | 163WC1500X | 75442 | CA | N | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.