Healthcare Provider Details

I. General information

NPI: 1346820446
Provider Name (Legal Business Name): KELLIE CHEVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 S BASCOM AVE STE 100
CAMPBELL CA
95008-5541
US

IV. Provider business mailing address

2542 S BASCOM AVE STE 100
CAMPBELL CA
95008-5541
US

V. Phone/Fax

Practice location:
  • Phone: 669-877-2527
  • Fax:
Mailing address:
  • Phone: 669-877-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISS KELLIE SUMMER CHEVES
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 925-209-3510