Provider Demographics
NPI:1073743704
Name:CHACON, YOLANDA J (DPM)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:J
Last Name:CHACON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 DORAL CT STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8616
Mailing Address - Country:US
Mailing Address - Phone:575-521-0055
Mailing Address - Fax:575-521-0077
Practice Address - Street 1:2800 DORAL CT STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8616
Practice Address - Country:US
Practice Address - Phone:575-521-0055
Practice Address - Fax:575-521-0077
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002337213E00000X, 213ES0103X, 213ES0131X
NM342213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery