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General NPI Number Information
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NPI Number | 1629261375
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Entity Type | Individual
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Provider Name | REYNA R CHAVEZ
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Gender | Female
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 1440 S STATE COLLEGE BLVD SUITE 3-K
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City | ANAHEIM
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State | CA
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Zip | 92806-5724
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Country | US
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Telephone | 714-758-0660
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Fax | 714-758-0770
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Provider Business Mailing Address
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Address Line | 1440 S STATE COLLEGE BLVD SUITE 3-K
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City | ANAHEIM
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State | CA
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Zip | 92806-5724
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Country | US
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Telephone | 714-758-0660
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Fax | 714-758-0770
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | FAC33625
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State | CA
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