Provider Demographics
NPI:1437579547
Name:CHAVEZ, ROXANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3635
Mailing Address - Country:US
Mailing Address - Phone:323-750-1196
Mailing Address - Fax:323-750-0330
Practice Address - Street 1:10723 PICO VISTA RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3056
Practice Address - Country:US
Practice Address - Phone:562-644-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily