Provider Demographics
NPI:1952075137
Name:CHAFART, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CHAFART
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 1:20934 LYCOMING ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3120
Mailing Address - Country:US
Mailing Address - Phone:714-404-9296
Mailing Address - Fax:714-643-7478
Practice Address - Street 1:20934 LYCOMING ST
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-3120
Practice Address - Country:US
Practice Address - Phone:714-404-9296
Practice Address - Fax:714-643-7478
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42994J1343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)