Provider Demographics
NPI:1275179954
Name:MERCADO CHAVEZ, JOSEFINA SAMONTE (BSFN, MSN)
Entity Type:Individual
Prefix:MS
First Name:JOSEFINA
Middle Name:SAMONTE
Last Name:MERCADO CHAVEZ
Suffix:
Gender:F
Credentials:BSFN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 24TH ST STE O
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8506
Mailing Address - Country:US
Mailing Address - Phone:928-955-0084
Mailing Address - Fax:928-955-0032
Practice Address - Street 1:250 W 24TH ST STE O
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8506
Practice Address - Country:US
Practice Address - Phone:928-955-0084
Practice Address - Fax:928-955-0032
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education