Provider Demographics
NPI:1508542895
Name:CHAVEZ ROMAN, JOSEPH JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAVIER
Last Name:CHAVEZ ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 CATALINA DRIVE
Mailing Address - Street 2:APT 02
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550
Mailing Address - Country:US
Mailing Address - Phone:313-502-7802
Mailing Address - Fax:
Practice Address - Street 1:6071 W. OUTER DR.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program