Provider Demographics
NPI:1023788965
Name:CHAVEZ RODRIGUEZ, LUIS A (APCC 10063)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:CHAVEZ RODRIGUEZ
Suffix:
Gender:M
Credentials:APCC 10063
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 ETA ST APT 1707
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-1425
Mailing Address - Country:US
Mailing Address - Phone:619-581-7010
Mailing Address - Fax:
Practice Address - Street 1:1161 BAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2670
Practice Address - Country:US
Practice Address - Phone:619-585-7686
Practice Address - Fax:619-585-7699
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional