MEDICARE: CHAVEZ MEDICAL GROUP, INC

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	261QM1300X	Multi-Specialty Clinic/Center
2	207R00000X	Internal Medicine Physician	A67620	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407129018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAVEZ MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	5260 N PALM AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2217
Country	:	US
Telephone Number	:	559-840-0066
Fax Number	:	559-272-0479

Provider Business Practice Location Address
First Line	:	5260 N PALM AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2217
Country	:	US
Telephone Number	:	559-840-0066
Fax Number	:	559-272-0479

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. JUAN G CHAVEZ
Credential	:	MD
Telephone Number	:	559-840-0066

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	12/19/2022

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Directions to “CHAVEZ MEDICAL GROUP, INC ” Practice Location

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