MEDICARE: ANTUANETE CHAVEZ BCABA

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
1	106E00000X	Assistant Behavior Analyst	0-21-12392	NV

General Provider Information

NPI Number	:	1467273912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTUANETE CHAVEZ BCABA

Provider Business Mailing Address
First Line	:	15150 W PARK PL STE 103
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-2386
Country	:	US
Telephone Number	:	818-940-4335
Fax Number	:	626-270-4094

Provider Business Practice Location Address
First Line	:	6873 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	818-940-4335
Fax Number	:	626-270-4094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “ ANTUANETE CHAVEZ BCABA” Practice Location

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