Provider Demographics
NPI:1114293933
Name:SAMUEL R. CHACON MD PC
Entity Type:Organization
Organization Name:SAMUEL R. CHACON MD PC
Other - Org Name:WOMEN'S HEALTH CENTER OF RENO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:RODOLFO
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:775-232-2356
Mailing Address - Street 1:540 W PLUMB LN STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3683
Mailing Address - Country:US
Mailing Address - Phone:775-870-1521
Mailing Address - Fax:775-870-1892
Practice Address - Street 1:540 W PLUMB LN STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-870-1521
Practice Address - Fax:775-870-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9105261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty