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Individual

REYNA R CHAVEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1440 S STATE COLLEGE BLVD, SUITE 3-K, ANAHEIM, CA 92806-5724
(714) 758-0660
(714) 758-0770
Mailing address
1440 S STATE COLLEGE BLVD, SUITE 3-K, ANAHEIM, CA 92806-5724
(714) 758-0660
(714) 758-0770

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
FAC33625
CA
261QR0207X
Mobile Mammography Clinic/Center
CA
261QR0208X
Mobile Radiology Clinic/Center
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CA236328
MEDICARE NORTHERN CALIFORNIA X-RAY PTAN
CA
01
CA268381
MEDICARE NORTHERN CALIFORNIA MAMMOGRAPHY PTAN
CA
01
CB207156
MEDICARE SOUTHERN CALIFORNIA X-RAY PTAN
CA
01
CB276312
MEDICARE LA COUNTY MAMMOGRAPHY PTAN
CA
01
CB284412
MEDICARE SOUTHERN CALIFORNIA MAMMOGRAPHY PTAN
CA
01
P01543590
RAILROAD MEDICARE PTAN
CA
Enumeration date
08/24/2007
Last updated
11/06/2017
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