Individual
CAROLE DENISE CHACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCCE, CLE, IBCLC
Contact information
Practice address
15245 TUBA ST, MISSION HILLS, CA 91345-2701
(818) 642-7629
Mailing address
15245 TUBA ST, MISSION HILLS, CA 91345-2701
(818) 642-7629
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10623355
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10623355
IBCLE
NC
01
—
1843
CAPPA
GA
Enumeration date
05/22/2007
Last updated
07/08/2007
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