Provider Demographics
NPI:1114192796
Name:CHACON, ROBERT (CO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:CHACON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 KNOLL DR STE D
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8058
Mailing Address - Country:US
Mailing Address - Phone:805-658-1388
Mailing Address - Fax:805-658-2636
Practice Address - Street 1:2300 KNOLL DR STE D
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8058
Practice Address - Country:US
Practice Address - Phone:805-658-1388
Practice Address - Fax:805-658-2636
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0257810001Medicare NSC