Healthcare Provider Details

I. General information

NPI: 1841101292
Provider Name (Legal Business Name): ROMY CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAN MARIN DR
NOVATO CA
94945-1117
US

IV. Provider business mailing address

1044 SUSAN WAY
NOVATO CA
94947-6917
US

V. Phone/Fax

Practice location:
  • Phone: 415-898-2121
  • Fax: 415-898-2121
Mailing address:
  • Phone: 916-832-9114
  • Fax: 916-832-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: