Provider Demographics
NPI:1255454658
Name:CHAVARRIA, NEREIDA OLYMPIA
Entity type:Individual
Prefix:
First Name:NEREIDA
Middle Name:OLYMPIA
Last Name:CHAVARRIA
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 1:9409 E GRAPEVINE SPRING PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-8128
Mailing Address - Country:US
Mailing Address - Phone:520-398-6198
Mailing Address - Fax:
Practice Address - Street 1:9409 E GRAPEVINE SPRING PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8128
Practice Address - Country:US
Practice Address - Phone:520-398-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12095385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child