Provider Demographics
NPI:1184015679
Name:CHAVEZ, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
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 1:13165 W LAKE HOUSTON PKWY
Mailing Address - Street 2:STE 431
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5391
Mailing Address - Country:US
Mailing Address - Phone:888-580-0011
Mailing Address - Fax:
Practice Address - Street 1:13423 YAUPON HOLLY LN
Practice Address - Street 2:SUMMERWOOD
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-4942
Practice Address - Country:US
Practice Address - Phone:888-580-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-3000413OtherEIN