Healthcare Provider Details

I. General information

NPI: 1679262042
Provider Name (Legal Business Name): CHERSTEN AZEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 W HENDERSON AVE STE 1
PORTERVILLE CA
93257-1777
US

IV. Provider business mailing address

177 W HENDERSON AVE STE 1
PORTERVILLE CA
93257-1777
US

V. Phone/Fax

Practice location:
  • Phone: 559-687-0929
  • Fax:
Mailing address:
  • Phone: 595-784-0312
  • Fax: 559-784-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number142240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: