Healthcare Provider Details

I. General information

NPI: 1962306241
Provider Name (Legal Business Name): KAITLYN ROSE CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 LION ST
ROCKLIN CA
95765-5735
US

IV. Provider business mailing address

1432 ARROWWOOD LN
ROSEVILLE CA
95747-4608
US

V. Phone/Fax

Practice location:
  • Phone: 669-221-5129
  • Fax:
Mailing address:
  • Phone: 214-609-2663
  • Fax:

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: