Healthcare Provider Details

I. General information

NPI: 1922933001
Provider Name (Legal Business Name): IVAN CHAVEZ APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 S 38TH ST
SAN DIEGO CA
92113-3210
US

IV. Provider business mailing address

1355 THIRD AVE
CHULA VISTA CA
91911-4302
US

V. Phone/Fax

Practice location:
  • Phone: 619-262-4002
  • Fax:
Mailing address:
  • Phone: 619-426-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: