Healthcare Provider Details

I. General information

NPI: 1336955699
Provider Name (Legal Business Name): CHRISTINA CHAVEZ-JOHNSON MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CROW CANYON CT STE 210
SAN RAMON CA
94583-1980
US

IV. Provider business mailing address

10 CROW CANYON CT STE 210
SAN RAMON CA
94583-1980
US

V. Phone/Fax

Practice location:
  • Phone: 925-519-2688
  • Fax:
Mailing address:
  • Phone: 925-519-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK KEHRET
Title or Position: ADMINISTRATOR
Credential:
Phone: 925-519-2688