Provider Demographics
NPI:1457522815
Name:CHAVEZ, MATEO PEREZ
Entity Type:Individual
Prefix:MR
First Name:MATEO
Middle Name:PEREZ
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22568 MISSION BLVD # 343
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5116
Mailing Address - Country:US
Mailing Address - Phone:415-548-0506
Mailing Address - Fax:
Practice Address - Street 1:3490 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4333
Practice Address - Country:US
Practice Address - Phone:415-506-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA110213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor