Provider Demographics
NPI:1164109930
Name:CHAVEZ, ROXANNA P (IBCLC)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:P
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MILLAR AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4227
Mailing Address - Country:US
Mailing Address - Phone:408-600-8176
Mailing Address - Fax:
Practice Address - Street 1:614 MILLAR AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4227
Practice Address - Country:US
Practice Address - Phone:408-600-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty