Provider Demographics
NPI:1245809482
Name:CHAVEZ, GLORIA
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-3529
Mailing Address - Country:US
Mailing Address - Phone:323-454-4860
Mailing Address - Fax:323-454-4870
Practice Address - Street 1:954 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3529
Practice Address - Country:US
Practice Address - Phone:323-454-4860
Practice Address - Fax:323-454-4870
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator