Basic Information
| Provider Information | |||||||||
| NPI: | 1568804607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHACON | ||||||||
| FirstName: | JASMIN | ||||||||
| MiddleName: | DANIELA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.A., PSY. S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 W 20TH PL | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853646528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285815081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4301 N FEDERAL HWY | ||||||||
| Address2: | SUITE 2 SOUTH | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330646519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888809270 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.