Provider Demographics
NPI:1295183283
Name:CHAPA, JONATHAN I (RDN, CSCS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:I
Last Name:CHAPA
Suffix:
Gender:M
Credentials:RDN, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 BLUE SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3047
Mailing Address - Country:US
Mailing Address - Phone:956-460-2488
Mailing Address - Fax:
Practice Address - Street 1:525 W ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6313
Practice Address - Country:US
Practice Address - Phone:956-460-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86032606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388257302Medicaid