Healthcare Provider Details

I. General information

NPI: 1124514872
Provider Name (Legal Business Name): JONATHAN MELVIN CHAMBLEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FOLSOM BLVD
SACRAMENTO CA
95826-3257
US

IV. Provider business mailing address

427 LA ESPERANZA DR
DIXON CA
95620-3039
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 707-635-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number00005173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: