Active NPI
Justin Chavez
- Licensed Psychiatric Technician
- Stockton, CA
National Provider Identifier
1396479606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 42379
- Practice address
- 1414 N California St # 2
Stockton, CA 95202-1515 - Phone
- (209) 468-8700
- NPI assigned
- Jul 12, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | |||
| Licensed Psychiatric Technician | 167G00000X | 42379 | CA | Primary |
Addresses
Primary practice location
1414 N California St # 2
Stockton, CA 95202-1515
Mailing address
248 E Downs St
Stockton, CA 95204-2006
Phone (209) 373-8805
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42379 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1396479606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 E DOWNS ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952042006",
"telephone_number": "209-373-8805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 N CALIFORNIA ST # 2",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021515",
"telephone_number": "209-468-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVEZ",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-12",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": null,
"license": null,
"primary": false
},
{
"code": "167G00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "42379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.