Individual
MR. JESSE ANTHONY CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 758-5936
Mailing address
154 NE CONIFER BLVD, CORVALLIS, OR 97330-4677
(503) 309-5890
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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