Provider Demographics
NPI:1568014264
Name:CHAVEZ, SANDRA DENISSE (RD)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DENISSE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DENISSE IRUBI
Other - Last Name:CHAVEZ LUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2001 DWIGHT WAY # B308
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2608
Mailing Address - Country:US
Mailing Address - Phone:510-204-2437
Mailing Address - Fax:
Practice Address - Street 1:2001 DWIGHT WAY # B308
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA086090624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered