Provider Demographics
NPI:1629418645
Name:CHAVEZ, CRYSTAL ELOSIE
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ELOSIE
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 1:6057 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-8211
Mailing Address - Country:US
Mailing Address - Phone:562-805-1423
Mailing Address - Fax:
Practice Address - Street 1:369 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3110
Practice Address - Country:US
Practice Address - Phone:310-603-6555
Practice Address - Fax:310-603-6565
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARRW7005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)