Provider Demographics
NPI:1043588049
Name:CHAVEZ, CARI ANN
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:ANN
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 1:45 N SKY LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8302
Mailing Address - Country:US
Mailing Address - Phone:575-208-8323
Mailing Address - Fax:
Practice Address - Street 1:45 N SKY LOOP
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8302
Practice Address - Country:US
Practice Address - Phone:575-208-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-055541041C0700X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist