=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073624193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE ANGEL CHAVEZ BA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 CAMINO DEL RIO S STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-287-8225
-----------------------------------------------------
Fax | 619-393-0386
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 CAMINO DEL RIO S STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-287-8225
-----------------------------------------------------
Fax | 619-393-0386
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------