Healthcare Provider Details

I. General information

NPI: 1972492890
Provider Name (Legal Business Name): ALEXIS CHAVEZ ESCOBEDO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10767 JAMACHA BLVD SPC 129
SPRING VALLEY CA
91978-1862
US

IV. Provider business mailing address

10767 JAMACHA BLVD SPC 129
SPRING VALLEY CA
91978-1862
US

V. Phone/Fax

Practice location:
  • Phone: 619-251-0335
  • Fax:
Mailing address:
  • Phone: 619-251-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: