Provider Demographics
NPI:1689419848
Name:CHACON ORELLANA, CARMEN VICTORIA (SA-C)
Entity type:Individual
Prefix:
First Name:CARMEN VICTORIA
Middle Name:
Last Name:CHACON ORELLANA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ELDRIDGE PKWY APT 6305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3471
Mailing Address - Country:US
Mailing Address - Phone:404-790-2624
Mailing Address - Fax:
Practice Address - Street 1:4704 MONTROSE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6122
Practice Address - Country:US
Practice Address - Phone:713-333-0151
Practice Address - Fax:832-485-5080
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-290246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant