Provider Demographics
NPI:1821799909
Name:LOVE, CHEYENNE XOCHITL
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:XOCHITL
Last Name:LOVE
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 1:709 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3202
Mailing Address - Country:US
Mailing Address - Phone:510-912-0122
Mailing Address - Fax:
Practice Address - Street 1:709 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3202
Practice Address - Country:US
Practice Address - Phone:669-444-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker