Provider Demographics
NPI:1114223740
Name:CHAVEZ, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 NW 103RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4698
Mailing Address - Country:US
Mailing Address - Phone:786-953-4754
Mailing Address - Fax:786-464-0561
Practice Address - Street 1:8302 NW 103RD ST STE 202
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-4698
Practice Address - Country:US
Practice Address - Phone:786-953-4754
Practice Address - Fax:786-464-0561
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA59656OtherFLORIDA DEPARTMENT OF HEALTH