Healthcare Provider Details

I. General information

NPI: 1003303850
Provider Name (Legal Business Name): ALEXA CHAVEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7196
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

17535 PINE CONE CT
MONTE SERENO CA
95030-2235
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7539
  • Fax:
Mailing address:
  • Phone: 408-386-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA173630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: