Healthcare Provider Details

I. General information

NPI: 1316852742
Provider Name (Legal Business Name): HEATHYR NICOLE CHAVARIN RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

IV. Provider business mailing address

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

V. Phone/Fax

Practice location:
  • Phone: 626-969-3434
  • Fax:
Mailing address:
  • Phone: 626-969-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number95243644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: