Healthcare Provider Details

I. General information

NPI: 1700649712
Provider Name (Legal Business Name): CODY CHAPA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19855 GUTHRIE DR
STRATHMORE CA
93267-8005
US

IV. Provider business mailing address

PO BOX 1268
STRATHMORE CA
93267-1268
US

V. Phone/Fax

Practice location:
  • Phone: 559-920-6527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: