Provider Demographics
NPI:1578253092
Name:CHAVEZ HERNANDEZ, TEOFILA
Entity Type:Individual
Prefix:
First Name:TEOFILA
Middle Name:
Last Name:CHAVEZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 HAVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1523
Mailing Address - Country:US
Mailing Address - Phone:832-276-4588
Mailing Address - Fax:
Practice Address - Street 1:3611 ENNIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4407
Practice Address - Country:US
Practice Address - Phone:832-393-4093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator