Provider Demographics
NPI:1801558267
Name:CHAVEZ, MARINA ELENA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ELENA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20463 N 81ST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2432
Mailing Address - Country:US
Mailing Address - Phone:623-293-2063
Mailing Address - Fax:
Practice Address - Street 1:8410 W THOMAS RD STE 124
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3373
Practice Address - Country:US
Practice Address - Phone:480-417-5289
Practice Address - Fax:602-812-7491
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
AZ9631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical