Healthcare Provider Details

I. General information

NPI: 1013560606
Provider Name (Legal Business Name): GRACIELA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 W SHAW AVE STE 102
FRESNO CA
93711-3518
US

IV. Provider business mailing address

1233 E GARRETT AVE
FRESNO CA
93706-4929
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-5900
  • Fax:
Mailing address:
  • Phone: 559-430-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: