Healthcare Provider Details

I. General information

NPI: 1700305497
Provider Name (Legal Business Name): JAMES M CHEGE BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 TISCH WAY
SAN JOSE CA
95128-2541
US

IV. Provider business mailing address

37847 NILES BLVD APT 2
FREMONT CA
94536-2943
US

V. Phone/Fax

Practice location:
  • Phone: 408-416-7536
  • Fax:
Mailing address:
  • Phone: 510-470-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12258117
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: