Healthcare Provider Details

I. General information

NPI: 1619679966
Provider Name (Legal Business Name): DONOVAN TALAWEPI CHASE THE BEAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DONOVAN CHASE

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST # 1600
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST # 1600
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3630
  • Fax: 916-734-5636
Mailing address:
  • Phone: 916-734-3630
  • Fax: 916-734-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: