Provider Demographics
NPI:1932777299
Name:CHACON, VICTORIA CAMERINA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CAMERINA
Last Name:CHACON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 WYATT EARP ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7209
Mailing Address - Country:US
Mailing Address - Phone:915-471-2529
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8122
Practice Address - Country:US
Practice Address - Phone:915-271-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist