Provider Demographics
NPI:1649723487
Name:CHAVEZ, ROXANA (MSW, PPSC)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 SOUTH POINT DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-855-1556
Mailing Address - Fax:949-951-2871
Practice Address - Street 1:23461 SOUTH POINT DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-855-1556
Practice Address - Fax:949-951-2871
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA904821041S0200X, 1041S0200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator