Healthcare Provider Details

I. General information

NPI: 1588445100
Provider Name (Legal Business Name): MR. RICARDO MARTINEZ CHAVEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK RD STE 100
WALNUT CREEK CA
94597-2078
US

IV. Provider business mailing address

18518 NORTHRIDGE DR
SALINAS CA
93906-1950
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-3959
  • Fax:
Mailing address:
  • Phone: 831-208-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: