Provider Demographics
NPI:1619567302
Name:CHAVEZ, MARIANO D JR
Entity Type:Individual
Prefix:DR
First Name:MARIANO
Middle Name:D
Last Name:CHAVEZ
Suffix:JR
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 1:3227 SE MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3876
Mailing Address - Country:US
Mailing Address - Phone:210-247-0083
Mailing Address - Fax:
Practice Address - Street 1:3227 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3876
Practice Address - Country:US
Practice Address - Phone:210-247-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy