Healthcare Provider Details

I. General information

NPI: 1558060566
Provider Name (Legal Business Name): JESSE C CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STOCKDALE HWY STE 275
BAKERSFIELD CA
93309-2667
US

IV. Provider business mailing address

2205 LUCKY ST
BAKERSFIELD CA
93307-2039
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-5000
  • Fax:
Mailing address:
  • Phone: 661-342-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: