Healthcare Provider Details

I. General information

NPI: 1881181378
Provider Name (Legal Business Name): JESSYCA FRANCO CHAVEZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E FAIRVIEW LN STE D
ESPANOLA NM
87532-2562
US

IV. Provider business mailing address

1003 E FAIRVIEW LN STE D
ESPANOLA NM
87532-2562
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-2055
  • Fax:
Mailing address:
  • Phone: 575-915-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number181702
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: