Provider Demographics
NPI:1477844280
Name:CHAVEZ, ALREDO
Entity Type:Individual
Prefix:MR
First Name:ALREDO
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 1:2460 STEAMBOAT SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2248
Mailing Address - Country:US
Mailing Address - Phone:619-532-6582
Mailing Address - Fax:
Practice Address - Street 1:2460 STEAMBOAT SPRINGS CT.
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915
Practice Address - Country:US
Practice Address - Phone:619-532-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman