Basic Information
| Provider Information | |||||||||
| NPI: | 1518548171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHACON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 EAST ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256860315 | ||||||||
| FaxNumber: | 9256860320 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 EAST ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256860315 | ||||||||
| FaxNumber: | 9256860320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2021 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95017153 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.