Individual
MR. EDWARD J. CHACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6700 JEFFERSON ST NE, SUITE D-2, ALBUQUERQUE, NM 87109-4382
(505) 288-3916
Mailing address
313 LA ENTRADA RD, LOS LUNAS, NM 87031-7617
(505) 620-9213
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/11/2006
Last updated
10/23/2013
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