Provider Demographics
NPI:1902159916
Name:CHAVEZ, ALEXIS GUADALUPE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GUADALUPE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MCCAIN BLVD BLDG 601
Mailing Address - Street 2:NAVAL AIR STATION NORTH ISLAND
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92135
Mailing Address - Country:US
Mailing Address - Phone:619-545-9311
Mailing Address - Fax:
Practice Address - Street 1:601 MCCAIN BLVD BLDG 601
Practice Address - Street 2:NAVAL AIR STATION NORTH ISLAND
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92135
Practice Address - Country:US
Practice Address - Phone:619-545-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN