Provider Demographics
NPI:1750273603
Name:CHACON, DIEGO ALEXANDER
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ALEXANDER
Last Name:CHACON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 COUNTRYBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1481
Mailing Address - Country:US
Mailing Address - Phone:408-807-9465
Mailing Address - Fax:
Practice Address - Street 1:2441 COUNTRYBROOK
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-1481
Practice Address - Country:US
Practice Address - Phone:408-807-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program