Provider Demographics
NPI:1215583315
Name:CHEVESICH, ISIDORA PAZ
Entity Type:Individual
Prefix:
First Name:ISIDORA
Middle Name:PAZ
Last Name:CHEVESICH
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 1:927 N 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3712
Mailing Address - Country:US
Mailing Address - Phone:786-580-6140
Mailing Address - Fax:
Practice Address - Street 1:927 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3712
Practice Address - Country:US
Practice Address - Phone:786-580-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst