Provider Demographics
NPI:1639890601
Name:CHAVES, NURI ENRIQUE
Entity type:Individual
Prefix:
First Name:NURI
Middle Name:ENRIQUE
Last Name:CHAVES
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 1:1680 MERIDIAN AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2719
Mailing Address - Country:US
Mailing Address - Phone:305-531-5341
Mailing Address - Fax:305-532-5322
Practice Address - Street 1:13390 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4135
Practice Address - Country:US
Practice Address - Phone:305-403-0654
Practice Address - Fax:305-403-0653
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health