Provider Demographics
NPI:1235465774
Name:CHAVEZ GUERRERO, ANGELO JULIO (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:JULIO
Last Name:CHAVEZ GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANGELO
Other - Middle Name:JULIO
Other - Last Name:CHAVEZ GUERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5535 SHELL RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8700
Mailing Address - Country:US
Mailing Address - Phone:251-422-2713
Mailing Address - Fax:
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431728207Q00000X
ALMD.28142207Q00000X
CA156523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA256291YUNMMedicare PIN
PA256291YEBKMedicare PIN