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General NPI Number Information
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NPI Number | 1548953458
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Entity Type | Individual
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Provider Name | CHESTER G PROFETA BSN, MSN
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Gender | Male
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 06/27/2026
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Provider Practice Location Address
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Address Line | 2571 SKYLARK DR
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City | SAN JOSE
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State | CA
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Zip | 95125-2942
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Country | US
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Telephone | 714-588-6659
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Fax |
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Provider Business Mailing Address
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Address Line | 2571 SKYLARK DR
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City | SAN JOSE
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State | CA
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Zip | 95125-2942
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Country | US
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Telephone | 714-588-6599
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704420286
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 846065
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License Number State | CA
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