Healthcare Provider Details

I. General information

NPI: 1154243590
Provider Name (Legal Business Name): SOLEDAD CHAVARRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 25TH ST
SAN DIEGO CA
92102-2107
US

IV. Provider business mailing address

1985 NATIONAL AVE APT 209
SAN DIEGO CA
92113-2157
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-0067
  • Fax: 619-233-3990
Mailing address:
  • Phone: 619-675-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: