Provider Demographics
NPI:1881866317
Name:CHAVEZ, MARTIN (LVN)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25279 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2350
Mailing Address - Country:US
Mailing Address - Phone:650-720-0688
Mailing Address - Fax:
Practice Address - Street 1:25279 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2350
Practice Address - Country:US
Practice Address - Phone:650-720-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN167050164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse