MEDICARE: CESAR CHAVEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1225712235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR CHAVEZ

Provider Business Mailing Address
First Line	:	PO BOX 717
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-0717
Country	:	US
Telephone Number	:	503-856-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-3788
Country	:	US
Telephone Number	:	503-722-4110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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Directions to “ CESAR CHAVEZ ” Practice Location

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