=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235465774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELO JULIO CHAVEZ GUERRERO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2009
-----------------------------------------------------
Last Update Date | 05/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 RIVERSIDE AVE
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-238-7250
-----------------------------------------------------
Fax | 805-238-0165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 S BLOSSER RD
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93458-7310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-361-8030
-----------------------------------------------------
Fax | 805-361-8017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD431728
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.28142
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 156523
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------