Healthcare Provider Details

I. General information

NPI: 1144111998
Provider Name (Legal Business Name): JOSE M CHAVEZ ED.D., BCET, ADHD-CE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E 103RD ST
LOS ANGELES CA
90002-3306
US

IV. Provider business mailing address

1465 E 103RD ST
LOS ANGELES CA
90002-3306
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-7911
  • Fax: 323-564-7911
Mailing address:
  • Phone: 323-564-7911
  • Fax: 323-569-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: