MEDICARE: NATHANIEL CHAVEZ I

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1447189584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL CHAVEZ I

Provider Business Mailing Address
First Line	:	2810 NUGGET AVE
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9494
Country	:	US
Telephone Number	:	760-379-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 NUGGET AVE
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9494
Country	:	US
Telephone Number	:	760-379-3651
Fax Number	:

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

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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