Provider Demographics
NPI:1659716116
Name:CHAVEZ, AIDE
Entity Type:Individual
Prefix:
First Name:AIDE
Middle Name:
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 1:8926 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1850
Mailing Address - Country:US
Mailing Address - Phone:626-485-8506
Mailing Address - Fax:
Practice Address - Street 1:121 LINDEN AVE STE B-108
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4990
Practice Address - Country:US
Practice Address - Phone:562-275-8966
Practice Address - Fax:562-735-4141
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF70689106H00000X
CALMFT117885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist