Provider Demographics
NPI:1619151594
Name:CHAVEZ, SAL CHRISTOPHER (MFT)
Entity Type:Individual
Prefix:MR
First Name:SAL
Middle Name:CHRISTOPHER
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6620
Mailing Address - Country:US
Mailing Address - Phone:310-741-1665
Mailing Address - Fax:
Practice Address - Street 1:2553 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6620
Practice Address - Country:US
Practice Address - Phone:310-741-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist