Provider Demographics
NPI:1073384608
Name:CHAVEZ-RANGEL, MARTHA ALICIA (FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALICIA
Last Name:CHAVEZ-RANGEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2904
Mailing Address - Country:US
Mailing Address - Phone:213-483-3600
Mailing Address - Fax:
Practice Address - Street 1:1401 W 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3757
Practice Address - Country:US
Practice Address - Phone:714-542-9700
Practice Address - Fax:714-542-9708
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner