Provider Demographics
NPI:1922782002
Name:CHAVEZ, ALDA SOFIA (MD)
Entity Type:Individual
Prefix:
First Name:ALDA
Middle Name:SOFIA
Last Name:CHAVEZ
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 1:482 W SAN YSIDRO BLVD STE 1733
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2444
Mailing Address - Country:US
Mailing Address - Phone:619-755-5908
Mailing Address - Fax:
Practice Address - Street 1:482 W SAN YSIDRO BLVD STE 1733
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2444
Practice Address - Country:US
Practice Address - Phone:619-755-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program