Provider Demographics
NPI:1437829223
Name:CHAVEZ, CHARLE
Entity Type:Individual
Prefix:
First Name:CHARLE
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 1:2802 WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-3959
Mailing Address - Country:US
Mailing Address - Phone:183-254-9849
Mailing Address - Fax:
Practice Address - Street 1:2802 WINDSOR LN
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-3959
Practice Address - Country:US
Practice Address - Phone:183-254-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization