Individual
JACOB CHAVEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
(503) 494-3633
Mailing address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
65159
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/06/2022
Last updated
10/15/2024
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