Provider Demographics
NPI:1649241514
Name:CHACON, WENDY G (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:G
Last Name:CHACON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:292 EUCLID AVENUE
Practice Address - Street 2:#220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114
Practice Address - Country:US
Practice Address - Phone:619-262-8624
Practice Address - Fax:619-262-6639
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90910OtherMD LICENSE