Individual
RODOLFO CHAVEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDA
Contact information
Practice address
44558 10TH ST W, LANCASTER, CA 93534-3333
(661) 206-2424
Mailing address
628 E AVENUE J11, LANCASTER, CA 93535-1231
(661) 877-1791
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
76623
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B8125284
—
CA
Enumeration date
09/22/2017
Last updated
09/22/2017
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