Provider Demographics
NPI:1619263449
Name:CHAVEZ, EMILIANO (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILIANO
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1731
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-1731
Mailing Address - Country:US
Mailing Address - Phone:619-818-8609
Mailing Address - Fax:
Practice Address - Street 1:414 ARROYO SECO LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-2040
Practice Address - Country:US
Practice Address - Phone:619-818-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist