Healthcare Provider Details

I. General information

NPI: 1518434141
Provider Name (Legal Business Name): JORDYNNE BEATRICE CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 QUAIL RUN CIR STE 203
SALINAS CA
93907-2364
US

IV. Provider business mailing address

201 JOHN ST STE A
SALINAS CA
93901-3345
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax:
Mailing address:
  • Phone: 831-649-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: