Healthcare Provider Details

I. General information

NPI: 1720917628
Provider Name (Legal Business Name): JESSA CARMELLE CALOPE CHATTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 KINGMAN DR
VACAVILLE CA
95687-3701
US

IV. Provider business mailing address

784 KINGMAN DR
VACAVILLE CA
95687-3701
US

V. Phone/Fax

Practice location:
  • Phone: 510-375-8917
  • Fax:
Mailing address:
  • Phone: 510-375-8917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95152650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: