Provider Demographics
NPI:1134928997
Name:MIXCO-CHAVEZ, MAYRA PATRICIA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:PATRICIA
Last Name:MIXCO-CHAVEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W FOOTHILL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3786
Mailing Address - Country:US
Mailing Address - Phone:951-289-5747
Mailing Address - Fax:
Practice Address - Street 1:8300 LIMONITE AVE STE G
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-5174
Practice Address - Country:US
Practice Address - Phone:951-289-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator