Healthcare Provider Details

I. General information

NPI: 1902638232
Provider Name (Legal Business Name): CONSUELO GIL CHAFFEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE CHAFFEE FNP

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 SYCAMORE AVE STE 100
VISTA CA
92081-7851
US

IV. Provider business mailing address

1146 MONTURA RD
SAN MARCOS CA
92078-5229
US

V. Phone/Fax

Practice location:
  • Phone: 760-249-7007
  • Fax:
Mailing address:
  • Phone: 760-330-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04240383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: