Provider Demographics
NPI:1477923027
Name:CHAVEZ, ALEXANDER (COTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2128
Mailing Address - Country:US
Mailing Address - Phone:909-374-2763
Mailing Address - Fax:
Practice Address - Street 1:1770 W LA HABRA BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5130
Practice Address - Country:US
Practice Address - Phone:714-773-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3295261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation