Provider Demographics
NPI:1780940908
Name:CHAVEZ, LESLIE LOU (MD PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LOU
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MSC 09 5030
Mailing Address - Street 2:I UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2223
Mailing Address - Fax:505-272-4639
Practice Address - Street 1:MSC 09 5030
Practice Address - Street 2:I UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2223
Practice Address - Fax:505-272-4639
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2016-00592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry