MEDICARE: CRYSTAL ADRIANA CHAVEZ PA-C

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	363A00000X	Physician Assistant	57917	CA

General Provider Information

NPI Number	:	1912539271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ADRIANA CHAVEZ PA-C

Provider Business Mailing Address
First Line	:	1617 N CALIFORNIA ST STE 2A
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6117
Country	:	US
Telephone Number	:	209-466-8546
Fax Number	:	209-466-3335

Provider Business Practice Location Address
First Line	:	1617 N CALIFORNIA ST STE 2A
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6117
Country	:	US
Telephone Number	:	209-466-8546
Fax Number	:	209-466-3335

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	03/02/2026

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