Provider Demographics
NPI:1790976181
Name:CHAVEZ, ANGELA RENEE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:RENEE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 ALAMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4442
Mailing Address - Country:US
Mailing Address - Phone:818-518-6437
Mailing Address - Fax:
Practice Address - Street 1:18440 HATTERAS ST
Practice Address - Street 2:APT # 18
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1909
Practice Address - Country:US
Practice Address - Phone:818-345-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 198000164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse