Healthcare Provider Details

I. General information

NPI: 1548953458
Provider Name (Legal Business Name): CHESTER G PROFETA BSN, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 SKYLARK DR
SAN JOSE CA
95125-2942
US

IV. Provider business mailing address

2571 SKYLARK DR
SAN JOSE CA
95125-2942
US

V. Phone/Fax

Practice location:
  • Phone: 714-588-6659
  • Fax:
Mailing address:
  • Phone: 714-588-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95030535
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704420286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: