Basic Information
| Provider Information | |||||||||
| NPI: | 1992115018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVES | ||||||||
| FirstName: | LINNEA | ||||||||
| MiddleName: | RUTH | ||||||||
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| NameSuffix: | |||||||||
| Credential: | RN FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1851 N RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | RIALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923768069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098742371 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1851 N RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | RIALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923768069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098742371 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2014 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95000670 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1992115018 | 05 | CA | MEDICAID |