Provider Demographics
NPI:1821606161
Name:CHAVEZ, MARIO JR (CSFA)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:CHAVEZ
Suffix:JR
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 RIVERCREST DR APT 1122
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4151
Mailing Address - Country:US
Mailing Address - Phone:361-779-4202
Mailing Address - Fax:
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3540
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant