Healthcare Provider Details

I. General information

NPI: 1659265122
Provider Name (Legal Business Name): AVISHEK CHAND RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15728 ROAD 29 1/2
MADERA CA
93636-2005
US

IV. Provider business mailing address

15728 ROAD 29 1/2 # A
MADERA CA
93636-2005
US

V. Phone/Fax

Practice location:
  • Phone: 408-665-9623
  • Fax:
Mailing address:
  • Phone: 559-796-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number01150839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: