Provider Demographics
NPI:1285621441
Name:DECHAVEZ, CARMELITO (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELITO
Middle Name:
Last Name:DECHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2116
Mailing Address - Country:US
Mailing Address - Phone:530-846-6231
Mailing Address - Fax:530-846-4051
Practice Address - Street 1:520 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2116
Practice Address - Country:US
Practice Address - Phone:530-846-6231
Practice Address - Fax:530-846-4051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27831Medicare UPIN