Provider Demographics
NPI:1720082563
Name:CHAVEZ, CESAR T (MD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:T
Last Name:CHAVEZ
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0790
Mailing Address - Country:US
Mailing Address - Phone:858-756-2944
Mailing Address - Fax:858-756-4043
Practice Address - Street 1:610 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3215
Practice Address - Country:US
Practice Address - Phone:760-335-3737
Practice Address - Fax:760-335-3662
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51615207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G516151Medicaid
CA00G516150Medicaid
CAWG51615CMedicare PIN
CAA93092Medicare UPIN
CA00G516151Medicaid
CA00G516150Medicaid