Provider Demographics
NPI:1467861013
Name:CHAVEZ-GIFFORD, DIANA LISA (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LISA
Last Name:CHAVEZ-GIFFORD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 EDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-7727
Mailing Address - Country:US
Mailing Address - Phone:469-844-3574
Mailing Address - Fax:
Practice Address - Street 1:613 EDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7727
Practice Address - Country:US
Practice Address - Phone:469-844-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11197880174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN