Provider Demographics
NPI:1912504416
Name:CHAVEZ MOJICA, KARLA (PMC54106)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:CHAVEZ MOJICA
Suffix:
Gender:F
Credentials:PMC54106
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3169
Mailing Address - Country:US
Mailing Address - Phone:509-941-0076
Mailing Address - Fax:
Practice Address - Street 1:620 S 12TH ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3169
Practice Address - Country:US
Practice Address - Phone:509-941-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPMC54106171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter