MEDICARE: DELYSSA CHAVEZ RN, PHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	744202	CA
2	163WC1500X	Community Health Registered Nurse	75442	CA

General Provider Information

NPI Number	:	1437480019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELYSSA CHAVEZ RN, PHN

Provider Business Mailing Address
First Line	:	5275 MARKET ST # G
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-2212
Country	:	US
Telephone Number	:	619-263-7090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5275 MARKET ST # G
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-2212
Country	:	US
Telephone Number	:	619-263-7090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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