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NPI Code Detail

MEDICARE: BRENDA CHAVEZ

MEDICARE: BRENDA CHAVEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1164074068
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA CHAVEZ
Provider Business Mailing Address
First Line : 737 N BRANNICK AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-3305
Country : US
Telephone Number : 323-215-9281
Fax Number :
Provider Business Practice Location Address
First Line : 1000 S FREMONT AVE # 5100
Second Line :
City : ALHAMBRA
State : CA
Zip : 91803-8800
Country : US
Telephone Number : 626-407-0740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2019
Last Update Date : 07/10/2019

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Directions to “ BRENDA CHAVEZ ” Practice Location

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