Healthcare Provider Details

I. General information

NPI: 1013521657
Provider Name (Legal Business Name): ROBERT ALEXIS CHACON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 IMPERIAL HWY
FULLERTON CA
92835-1145
US

IV. Provider business mailing address

401 IMPERIAL HWY
FULLERTON CA
92835-1145
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7074
  • Fax:
Mailing address:
  • Phone: 714-447-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: