Healthcare Provider Details

I. General information

NPI: 1861954463
Provider Name (Legal Business Name): ALEXANDRIA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date: 05/27/2025
Reactivation Date: 06/18/2025

III. Provider practice location address

3576 ARLINGTON AVE
RIVERSIDE CA
92506-3943
US

IV. Provider business mailing address

8019 COMPTON AVE
LOS ANGELES CA
90001-3409
US

V. Phone/Fax

Practice location:
  • Phone: 195-137-4155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: