Healthcare Provider Details

I. General information

NPI: 1730869587
Provider Name (Legal Business Name): DAISY MERCEDES CHAVEZ-SANCHEZ CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MOWRY AVE STE 130
FREMONT CA
94538-1605
US

IV. Provider business mailing address

2500 MOWRY AVE STE 130
FREMONT CA
94538-1605
US

V. Phone/Fax

Practice location:
  • Phone: 510-790-1911
  • Fax: 510-505-9160
Mailing address:
  • Phone: 510-790-1911
  • Fax: 510-505-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberCFM03537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: