Healthcare Provider Details

I. General information

NPI: 1083004477
Provider Name (Legal Business Name): RITA CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56669 29 PALMS HWY STE E
YUCCA VALLEY CA
92284-5229
US

IV. Provider business mailing address

7425 CHURCH ST SPC 19
YUCCA VALLEY CA
92284-3279
US

V. Phone/Fax

Practice location:
  • Phone: 760-625-0137
  • Fax: 888-247-5097
Mailing address:
  • Phone: 717-446-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95387111
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: