=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063880524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSCAR CHAVEZ FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2015
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 SOUTH IMPERIAL AVENUE SUITE 15
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-339-2802
-----------------------------------------------------
Fax | 760-355-9520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 WEST ATEN ROAD SUITE 2
-----------------------------------------------------
City | IMPERIAL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92251-9805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-355-7730
-----------------------------------------------------
Fax | 760-355-7731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95002909
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP95002909
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------