Provider Demographics
NPI:1801687371
Name:CHAVEZ-SANTOS, MITZI GABRIELA
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:GABRIELA
Last Name:CHAVEZ-SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:GABRIELA
Other - Last Name:SANTOS-PACHECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12623 AVENUE 416
Mailing Address - Street 2:
Mailing Address - City:OROSI
Mailing Address - State:CA
Mailing Address - Zip Code:93647-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12623 AVENUE 416
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-2017
Practice Address - Country:US
Practice Address - Phone:559-528-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool