Provider Demographics
NPI:1386461663
Name:CHAVIRA, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CHAVIRA
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 1:5817 VISTA SAN GUADALUPE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5666
Mailing Address - Country:US
Mailing Address - Phone:619-549-1779
Mailing Address - Fax:
Practice Address - Street 1:5817 VISTA SAN GUADALUPE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-5666
Practice Address - Country:US
Practice Address - Phone:619-549-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program