Provider Demographics
NPI:1508621475
Name:CHACON, CECILIA ANN
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANN
Last Name:CHACON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27341 READ ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-6936
Mailing Address - Country:US
Mailing Address - Phone:951-476-5957
Mailing Address - Fax:
Practice Address - Street 1:27341 READ ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-6936
Practice Address - Country:US
Practice Address - Phone:951-476-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty