Healthcare Provider Details

I. General information

NPI: 1275179954
Provider Name (Legal Business Name): JOSEFINA SAMONTE MERCADO CHAVEZ BSFN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 24TH ST STE O
YUMA AZ
85364-8506
US

IV. Provider business mailing address

250 W 24TH ST STE O
YUMA AZ
85364-8506
US

V. Phone/Fax

Practice location:
  • Phone: 928-955-0084
  • Fax: 928-955-0032
Mailing address:
  • Phone: 928-955-0084
  • Fax: 928-955-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: