Provider Demographics
NPI:1902368541
Name:CHAVEZ, RAYMOND CARMEL (MA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CARMEL
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S ENCINA AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6605
Mailing Address - Country:US
Mailing Address - Phone:951-965-6367
Mailing Address - Fax:
Practice Address - Street 1:108 S ENCINA AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6605
Practice Address - Country:US
Practice Address - Phone:951-965-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty