Healthcare Provider Details

I. General information

NPI: 1720082563
Provider Name (Legal Business Name): CESAR T CHAVEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S 8TH ST
EL CENTRO CA
92243-3215
US

IV. Provider business mailing address

PO BOX 790
SOLANA BEACH CA
92075-0790
US

V. Phone/Fax

Practice location:
  • Phone: 760-335-3737
  • Fax: 760-335-3662
Mailing address:
  • Phone: 858-756-2944
  • Fax: 858-756-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG51615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: