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General NPI Number Information
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NPI Number | 1033130810
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Entity Type | Individual
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Provider Name | MANUEL CHAVEZ FNP
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 40 PENNY LN
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City | WATSONVILLE
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State | CA
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Zip | 95076-6008
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Country | US
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Telephone | 831-768-0412
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Fax | 831-763-6493
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Provider Business Mailing Address
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Address Line | 650 LLAGAS VISTA DR
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City | MORGAN HILL
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State | CA
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Zip | 95037-3446
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Country | US
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Telephone | 831-768-0412
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Fax | 831-763-6493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 521663
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License Number State | TX
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