Healthcare Provider Details

I. General information

NPI: 1477214948
Provider Name (Legal Business Name): JESUS ALEX CHAVEZ-ROJAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W MORTON AVE
PORTERVILLE CA
93257-2331
US

IV. Provider business mailing address

21326 AVENUE 245
LINDSAY CA
93247-9795
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-0452
  • Fax:
Mailing address:
  • Phone: 559-586-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: