Provider Demographics
NPI:1073716510
Name:CHAVEZ, YVETTE (MA)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVENUE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2634
Mailing Address - Country:US
Mailing Address - Phone:951-369-7288
Mailing Address - Fax:951-369-1064
Practice Address - Street 1:7177 BROCKTON AVENUE
Practice Address - Street 2:SUITE 335
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2634
Practice Address - Country:US
Practice Address - Phone:951-369-7288
Practice Address - Fax:951-369-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41994106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist