Provider Demographics
NPI:1033130810
Name:CHAVEZ, MANUEL (FNP)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LLAGAS VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3446
Mailing Address - Country:US
Mailing Address - Phone:831-768-0412
Mailing Address - Fax:831-763-6493
Practice Address - Street 1:40 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6008
Practice Address - Country:US
Practice Address - Phone:831-768-0412
Practice Address - Fax:831-763-6493
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner