Provider Demographics
NPI:1477214948
Name:CHAVEZ-ROJAS, JESUS ALEX
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALEX
Last Name:CHAVEZ-ROJAS
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 1:21326 AVENUE 245
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-9795
Mailing Address - Country:US
Mailing Address - Phone:559-586-0037
Mailing Address - Fax:
Practice Address - Street 1:66 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2331
Practice Address - Country:US
Practice Address - Phone:559-788-0452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist