Healthcare Provider Details

I. General information

NPI: 1568763233
Provider Name (Legal Business Name): CHRISTINA XOCHI ROSE CHAVEZ-JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 INTERNATIONAL BLVD.
OAKLAND CA
94606
US

IV. Provider business mailing address

P.O. BOX 22210
OAKLAND CA
94623
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-5400
  • Fax: 510-238-5437
Mailing address:
  • Phone: 510-535-2965
  • Fax: 510-535-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number118528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: