Healthcare Provider Details

I. General information

NPI: 1205744851
Provider Name (Legal Business Name): CLINT J CHAPEL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 SUSAN WAY
SONORA CA
95370-9266
US

IV. Provider business mailing address

17405 HIGHWAY 108
JAMESTOWN CA
95327-9764
US

V. Phone/Fax

Practice location:
  • Phone: 510-456-0842
  • Fax:
Mailing address:
  • Phone: 209-694-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1871191569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: