Provider Demographics
NPI:1922112697
Name:CHACON, MONICA M (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:CHACON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2729
Mailing Address - Country:US
Mailing Address - Phone:702-247-9994
Mailing Address - Fax:702-651-9995
Practice Address - Street 1:2380 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5078
Practice Address - Country:US
Practice Address - Phone:702-247-9994
Practice Address - Fax:702-651-9995
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV179722084N0402X
AZ412982084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394996Medicaid
AZZ127425Medicare PIN
AZ394996Medicaid