Healthcare Provider Details

I. General information

NPI: 1447899349
Provider Name (Legal Business Name): MISS SAGRARIO ALVA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAGRARIO CHAVEZ 1248 WEST PARK ST.
STOCKTON CA
95203
US

IV. Provider business mailing address

SAGRARIO CHAVEZ 1248 WEST PARK ST.
STOCKTON CA
95203
US

V. Phone/Fax

Practice location:
  • Phone: 209-227-9510
  • Fax:
Mailing address:
  • Phone: 209-227-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: