Provider Demographics
NPI:1770840860
Name:CHAVEZ, GERVETTE R
Entity Type:Individual
Prefix:
First Name:GERVETTE
Middle Name:R
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 1:750 MORRIS RD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-0000
Mailing Address - Country:US
Mailing Address - Phone:505-866-2300
Mailing Address - Fax:505-866-2309
Practice Address - Street 1:750 MORRIS RD SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-0000
Practice Address - Country:US
Practice Address - Phone:505-866-2300
Practice Address - Fax:505-866-2309
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator