Provider Demographics
NPI:1043026008
Name:CHAVEZ, JOSE GABRIEL
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:GABRIEL
Last Name:CHAVEZ
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 1:11401 NW 29TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1638
Mailing Address - Country:US
Mailing Address - Phone:305-799-6552
Mailing Address - Fax:
Practice Address - Street 1:11401 NW 29TH PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1638
Practice Address - Country:US
Practice Address - Phone:305-799-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9532123163W00000X
FLAPRN11036668363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse