Provider Demographics
NPI:1649002593
Name:CHAVEZ, ELEAZAR (MT)
Entity type:Individual
Prefix:
First Name:ELEAZAR
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N ELDERBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1018
Mailing Address - Country:US
Mailing Address - Phone:626-484-6074
Mailing Address - Fax:
Practice Address - Street 1:1335 N ELDERBERRY AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1018
Practice Address - Country:US
Practice Address - Phone:626-484-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist