Provider Demographics
NPI:1548385305
Name:CHEVALIER, MARTHA ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALICIA
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S BASCOM AVE
Mailing Address - Street 2:DEPARTMENT OF INTERVENTIONAL RADIOLOGY
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2603
Mailing Address - Country:US
Mailing Address - Phone:408-885-5000
Mailing Address - Fax:408-793-4256
Practice Address - Street 1:750 S BASCOM AVE
Practice Address - Street 2:DEPT. OF INTERVENTIONAL RADIOLOGY
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2603
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:408-793-4256
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1076405363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical