Healthcare Provider Details

I. General information

NPI: 1093647604
Provider Name (Legal Business Name): WAYNENISHA DELTRINA CHAVEZ BT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 PLAZA DR
ROCKLIN CA
95765-4404
US

IV. Provider business mailing address

2202 PLAZA DR
ROCKLIN CA
95765-4404
US

V. Phone/Fax

Practice location:
  • Phone: 916-580-1103
  • Fax: 916-749-4520
Mailing address:
  • Phone: 916-580-1103
  • Fax: 916-749-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: