Healthcare Provider Details

I. General information

NPI: 1932888500
Provider Name (Legal Business Name): ANDRE SALVADOR FERNANDEZ CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CALLE TECATE STE 201
CAMARILLO CA
93012-5056
US

IV. Provider business mailing address

3601 CALLE TECATE STE 201
CAMARILLO CA
93012-5056
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-0120
  • Fax: 805-289-0130
Mailing address:
  • Phone: 805-289-0120
  • Fax: 805-289-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: