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NPI Code Detail

MEDICARE: RAFAEL UBALDO CHAVEZ PA

MEDICARE: RAFAEL UBALDO CHAVEZ PA
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
1363AM0700XMedical Physician AssistantPA12656CA

General Provider Information

NPI Number : 1346352085
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAFAEL UBALDO CHAVEZ PA
Provider Business Mailing Address
First Line : 3651 AGATE WAY
Second Line :
City : WEST COVINA
State : CA
Zip : 91792-2775
Country : US
Telephone Number : 626-912-1460
Fax Number : 626-912-1696
Provider Business Practice Location Address
First Line : 17487 HURLEY ST
Second Line :
City : CITY OF INDUSTRY
State : CA
Zip : 91744-5106
Country : US
Telephone Number : 626-965-0959
Fax Number : 626-912-1696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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Directions to “ RAFAEL UBALDO CHAVEZ PA” Practice Location

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