Healthcare Provider Details

I. General information

NPI: 1720936172
Provider Name (Legal Business Name): VANESSA KAYLA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 11TH ST
ORANGE COVE CA
93646-2018
US

IV. Provider business mailing address

235 11TH ST
ORANGE COVE CA
93646-2018
US

V. Phone/Fax

Practice location:
  • Phone: 559-643-1631
  • Fax: 559-643-1631
Mailing address:
  • Phone: 559-643-1631
  • Fax: 559-643-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number471630058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: