Individual provider Active NPI

Angela Tilatha Chavez

  • Case Manager/Care Coordinator
  • Palo Alto, CA
National Provider Identifier
1497314025
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
4139 El Camino Way
Palo Alto, CA 94306-4010
Phone
(650) 999-7069
Fax
(408) 642-6052
NPI assigned
Jun 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1346528106 CA
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

4139 El Camino Way
Palo Alto, CA 94306-4010

Mailing address

1922 The Alameda Ste 316
San Jose, CA 95126-1461
Phone (408) 261-7777

Other identifiers 1

IdentifierTypeStateIssuer
1346528106MedicaidCA

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

LicenseStateTypeSpecialty
1346528106CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Momentum for Health Case Manager/Care Coordinator CurrentSince Apr 21, 2024 Accepting new patients
Momentum for Health CurrentSince Apr 21, 2024 Accepting new patients

Locations

4139 El Camino Way
Palo Alto, CA 94306
Phone (650) 617-8340

1922 The Alameda
Ste 316
San Jose, CA 95126
Phone (408) 637-0341

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1497314025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 THE ALAMEDA STE 316",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261461",
            "telephone_number": "408-261-7777",
            "fax_number": "408-642-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4139 EL CAMINO WAY",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943064010",
            "telephone_number": "650-999-7069",
            "fax_number": "408-642-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "ANGELA",
        "middle_name": "TILATHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-07",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "1346528106",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346528106",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.

Verify at the official NPI Registry.