Provider Demographics
NPI:1780061440
Name:CHAVEZ SANTOS, MARIA JOSE (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:CHAVEZ SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:CHAVEZ SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1295 CARLSBAD VILLAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1950
Mailing Address - Country:US
Mailing Address - Phone:760-736-6767
Mailing Address - Fax:760-736-8740
Practice Address - Street 1:1295 CARLSBAD VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1950
Practice Address - Country:US
Practice Address - Phone:760-736-6767
Practice Address - Fax:760-736-8740
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC192775207Q00000X
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program