Provider Demographics
NPI:1073771069
Name:CHAVIS, ANTHONY C (RT (T))
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:CHAVIS
Suffix:
Gender:M
Credentials:RT (T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 JAMACHA BLVD
Mailing Address - Street 2:SPACE 197
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1829
Mailing Address - Country:US
Mailing Address - Phone:619-937-1164
Mailing Address - Fax:
Practice Address - Street 1:10767 JAMACHA BLVD
Practice Address - Street 2:SPACE 197
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1829
Practice Address - Country:US
Practice Address - Phone:619-937-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA844972471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy