Provider Demographics
NPI:1275823783
Name:CHAVEZ, JULIANA BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:BERNADETTE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WILLIAM STREET SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-768-5450
Mailing Address - Fax:505-842-1185
Practice Address - Street 1:1401 WILLIAM ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4661
Practice Address - Country:US
Practice Address - Phone:505-768-5450
Practice Address - Fax:505-842-1185
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMMD2013-0833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program