Provider Demographics
NPI:1881181378
Name:FRANCO CHAVEZ, JESSYCA (ND)
Entity Type:Individual
Prefix:DR
First Name:JESSYCA
Middle Name:
Last Name:FRANCO CHAVEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 E FAIRVIEW LN STE D
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2562
Mailing Address - Country:US
Mailing Address - Phone:575-915-2055
Mailing Address - Fax:
Practice Address - Street 1:1003 E FAIRVIEW LN STE D
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2562
Practice Address - Country:US
Practice Address - Phone:575-915-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ181702175F00000X
NMND0004175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMIICYFCBQEKMedicaid