Healthcare Provider Details

I. General information

NPI: 1457928012
Provider Name (Legal Business Name): ALEXIS VICTORIA CHAET-LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS VICTORIA CHAET

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LOMBARDI CT
SANTA ROSA CA
95407-6798
US

IV. Provider business mailing address

120 STONY POINT RD STE 120
SANTA ROSA CA
95401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-3600
  • Fax:
Mailing address:
  • Phone: 707-387-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61535631
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA182915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: