Provider Demographics
NPI:1194375568
Name:CHAVEZ, VICTORIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E HOLT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5720
Mailing Address - Country:US
Mailing Address - Phone:909-623-7799
Mailing Address - Fax:
Practice Address - Street 1:1019 E HOLT AVE STE A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5720
Practice Address - Country:US
Practice Address - Phone:909-623-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95130677163W00000X
CA95016983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse