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General NPI Number Information
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NPI Number | 1194172809
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Entity Type | Individual
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Provider Name | ELIZA CHACON
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 945 S BILLINGS WAY
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City | ANAHEIM
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State | CA
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Zip | 92808-2380
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Country | US
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Telephone | 575-528-9667
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Fax |
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Provider Business Mailing Address
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Address Line | 945 S BILLINGS WAY
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City | ANAHEIM
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State | CA
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Zip | 92808-2380
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Country | US
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Telephone | 575-528-9667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA53738
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License Number State | CA
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