Provider Demographics
NPI:1235878406
Name:CHAVEZ, AMADA MARIA
Entity Type:Individual
Prefix:
First Name:AMADA
Middle Name:MARIA
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 1:501 S RANCHO DR STE E33
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4833
Mailing Address - Country:US
Mailing Address - Phone:702-483-6302
Mailing Address - Fax:702-483-6313
Practice Address - Street 1:501 S RANCHO DR STE E33
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4833
Practice Address - Country:US
Practice Address - Phone:702-483-6302
Practice Address - Fax:702-483-6313
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant