Provider Demographics
NPI:1578966099
Name:CHAVEZ, TOMAS
Entity Type:Individual
Prefix:MR
First Name:TOMAS
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 1:6699 ALMERIA ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1302
Mailing Address - Country:US
Mailing Address - Phone:909-229-0837
Mailing Address - Fax:909-350-9319
Practice Address - Street 1:6699 ALMERIA ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1302
Practice Address - Country:US
Practice Address - Phone:909-229-0837
Practice Address - Fax:909-350-9319
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)