Healthcare Provider Details

I. General information

NPI: 1821907973
Provider Name (Legal Business Name): YAMILET CAMPOS-CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13161 JEFFERSON ST
LE GRAND CA
95333-9766
US

IV. Provider business mailing address

13161 JEFFERSON ST
LE GRAND CA
95333-9766
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax:
Mailing address:
  • Phone: 209-722-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number140222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: