Healthcare Provider Details

I. General information

NPI: 1215346119
Provider Name (Legal Business Name): CHA VUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18217 HALE AVE
MORGAN HILL CA
95037-3550
US

IV. Provider business mailing address

18217 HALE AVE
MORGAN HILL CA
95037-3550
US

V. Phone/Fax

Practice location:
  • Phone: 408-465-8280
  • Fax: 408-465-8295
Mailing address:
  • Phone: 408-465-8280
  • Fax: 408-465-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: