Provider Demographics
NPI:1679866743
Name:CHAIDEZ, WENDY (BA IN SOCIOLOGY)
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:
Last Name:CHAIDEZ
Suffix:
Gender:F
Credentials:BA IN SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-5236
Mailing Address - Country:US
Mailing Address - Phone:213-820-0858
Mailing Address - Fax:
Practice Address - Street 1:15339 SATICOY STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-267-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management