Provider Demographics
NPI:1073366035
Name:CHAVEZ, JOSE FELICIANO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FELICIANO
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1937
Mailing Address - Country:US
Mailing Address - Phone:530-691-4446
Mailing Address - Fax:530-691-4454
Practice Address - Street 1:1401 GOLD ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1937
Practice Address - Country:US
Practice Address - Phone:530-691-4446
Practice Address - Fax:530-691-4454
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
CAMPSS-OGIJYM175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator