Provider Demographics
NPI:1104696707
Name:CHAVARIN, ARNULFO JR
Entity type:Individual
Prefix:MR
First Name:ARNULFO
Middle Name:
Last Name:CHAVARIN
Suffix:JR
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 1:6819 RADIO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-1611
Mailing Address - Country:US
Mailing Address - Phone:619-770-7072
Mailing Address - Fax:
Practice Address - Street 1:6819 RADIO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-1611
Practice Address - Country:US
Practice Address - Phone:619-770-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 133NN1002X, 171M00000X, 225C00000X, 374K00000X
CAE1713416172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner