Provider Demographics
NPI:1538731302
Name:CHAVEZ, ANA KAREN
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:KAREN
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 1:1410 LINCOLN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2032
Mailing Address - Country:US
Mailing Address - Phone:415-827-9830
Mailing Address - Fax:
Practice Address - Street 1:1410 LINCOLN AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2032
Practice Address - Country:US
Practice Address - Phone:415-827-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse