Provider Demographics
NPI:1164496386
Name:CHASE, AVA LOU CARMICHAEL (ARNP)
Entity Type:Individual
Prefix:DR
First Name:AVA
Middle Name:LOU CARMICHAEL
Last Name:CHASE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:EAGLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:
Practice Address - Street 1:5454 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3621
Practice Address - Country:US
Practice Address - Phone:619-515-2400
Practice Address - Fax:619-546-9900
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95000602Other95000602