Healthcare Provider Details

I. General information

NPI: 1134687700
Provider Name (Legal Business Name): CHELSEA ALEXANDRA HOPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4074 FAIRMOUNT AVE STE B
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

18831 CYPRESS MOUNTAIN DR
SPRING TX
77388-5167
US

V. Phone/Fax

Practice location:
  • Phone: 619-996-9543
  • Fax:
Mailing address:
  • Phone: 713-202-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number107108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: