1730209966 NPI number — CESAR T. CHAVEZ MD, INC.

Table of content: (NPI 1730209966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730209966 NPI number — CESAR T. CHAVEZ MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CESAR T. CHAVEZ MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730209966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLANA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92075-0790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-756-2944
Provider Business Mailing Address Fax Number:
858-756-4043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-335-3737
Provider Business Practice Location Address Fax Number:
760-335-3662
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHAVEZ
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
858-756-2944

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G51615 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G516150 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G516151 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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