Provider Demographics
NPI:1699794594
Name:CONVALECER, WILLIAM DECHAVEZ (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DECHAVEZ
Last Name:CONVALECER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE WILLIAM
Other - Middle Name:DECHAVEZ
Other - Last Name:CONVALECER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1509 WILSON TERRACE
Mailing Address - Street 2:GLENDALE ADVENTIST MEDICAL CENTER
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:818-409-8000
Mailing Address - Fax:
Practice Address - Street 1:1509 WILSON TERRACE
Practice Address - Street 2:GLENDALE ADVENTIST MEDICAL CENTER
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28919207R00000X
UT7256117-1205208M00000X
CAC54615208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC28919OtherSTATE MEDICAL LICENSE
NC2009-00340OtherMEDICAL LICENSE
CAC54615OtherSTATE LICENSE
IDM10992OtherMEDICAL LICENSE
NC2009-00340OtherMEDICAL LICENSE