Provider Demographics
NPI:1619656121
Name:CHAVOOR, TRACIE (MS, RDN)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:
Last Name:CHAVOOR
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:93453-0740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22673 F ST
Practice Address - Street 2:
Practice Address - City:SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:93453-0740
Practice Address - Country:US
Practice Address - Phone:559-304-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered