Healthcare Provider Details

I. General information

NPI: 1932036704
Provider Name (Legal Business Name): TAE CHAVEZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MONO ST
FRESNO CA
93706-3857
US

IV. Provider business mailing address

5752 N SHERMAN AVE
FRESNO CA
93710-6233
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-3010
  • Fax:
Mailing address:
  • Phone: 559-755-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: