Provider Demographics
NPI:1952534067
Name:CHAVEZ, LUPE VEGA
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:VEGA
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 1:3840 ORCUTT GAREY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-9629
Mailing Address - Country:US
Mailing Address - Phone:805-937-2826
Mailing Address - Fax:805-937-2296
Practice Address - Street 1:3840 ORCUTT GAREY RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-9629
Practice Address - Country:US
Practice Address - Phone:805-937-2826
Practice Address - Fax:805-937-2296
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689762486OtherMCMILLAN RANCH