Provider Demographics
NPI:1912269887
Name:CHAVEZ, JUAN MANUEL (RN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 BAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-5312
Mailing Address - Country:US
Mailing Address - Phone:650-330-7400
Mailing Address - Fax:650-321-1156
Practice Address - Street 1:1798 BAY RD STE A
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-5312
Practice Address - Country:US
Practice Address - Phone:650-330-7400
Practice Address - Fax:650-321-1156
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765205163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse