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General NPI Number Information
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NPI Number | 1669025649
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Entity Type | Individual
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Provider Name | JOSE MANUEL CHAVARRIA SURGICAL ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 4401 GARTH RD
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City | BAYTOWN
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State | TX
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Zip | 77521-2122
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Country | US
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Telephone | 281-420-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 613 NORTHBEND DR
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City | BAYTOWN
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State | TX
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Zip | 77521-4424
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Country | US
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Telephone | 936-235-9104
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 17-438
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00906
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License Number State | TX
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