Provider Demographics
NPI:1417319567
Name:CHAVEZ, CY
Entity Type:Individual
Prefix:DR
First Name:CY
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 1:908 SAN SABA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6222
Mailing Address - Country:US
Mailing Address - Phone:817-946-7208
Mailing Address - Fax:
Practice Address - Street 1:4590 CHILDRENS PL FL PLACE6
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1020
Practice Address - Country:US
Practice Address - Phone:314-454-4127
Practice Address - Fax:314-454-4298
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program