Provider Demographics
NPI:1912315979
Name:CHAVEZ, RAVEN ELISE (MPAS PA-C)
Entity Type:Individual
Prefix:MISS
First Name:RAVEN
Middle Name:ELISE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MPAS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 NORMA LN APT 3
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5992
Mailing Address - Country:US
Mailing Address - Phone:956-388-0770
Mailing Address - Fax:
Practice Address - Street 1:201 S LOS EBANOS RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-1139
Practice Address - Country:US
Practice Address - Phone:956-519-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3399909-01Medicaid
TX3399909-01Medicaid