Provider Demographics
NPI:1447899349
Name:CHAVEZ, SAGRARIO ALVA
Entity type:Individual
Prefix:MISS
First Name:SAGRARIO
Middle Name:ALVA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAGRARIO CHAVEZ
Mailing Address - Street 2:1248 WEST PARK ST.
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203
Mailing Address - Country:US
Mailing Address - Phone:209-227-9510
Mailing Address - Fax:
Practice Address - Street 1:SAGRARIO CHAVEZ
Practice Address - Street 2:1248 WEST PARK ST.
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203
Practice Address - Country:US
Practice Address - Phone:209-227-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91037885A76056Medicaid