Provider Demographics
NPI:1457682221
Name:CHAVES, JUAN (ETC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:CHAVES
Suffix:
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 NW 7TH ST
Mailing Address - Street 2:SUITE # 15-16
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2300
Mailing Address - Country:US
Mailing Address - Phone:305-460-9945
Mailing Address - Fax:305-460-9947
Practice Address - Street 1:4545 NW 7TH ST
Practice Address - Street 2:SUITE # 15-16
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2300
Practice Address - Country:US
Practice Address - Phone:305-460-9945
Practice Address - Fax:305-460-9947
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44479170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA44479OtherCLINIC/CENTER- HEALTH SERVICES