Provider Demographics
NPI:1588206528
Name:CHAVEZ, ERIKA K
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:K
Last Name:CHAVEZ
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 1:4894 WAGON WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2544
Mailing Address - Country:US
Mailing Address - Phone:707-360-8004
Mailing Address - Fax:
Practice Address - Street 1:526 KIRKWOOD CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7074
Practice Address - Country:US
Practice Address - Phone:707-360-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician