Healthcare Provider Details

I. General information

NPI: 1518423755
Provider Name (Legal Business Name): LUIS ALBERTO CHAVIEDO GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 NILES ST
BAKERSFIELD CA
93306-4922
US

IV. Provider business mailing address

7800 NILES ST
BAKERSFIELD CA
93306-4922
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-8284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPTL18357
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number18-529
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: