MEDICARE: VICTORIA 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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497421184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CHAVEZ

Provider Business Mailing Address
First Line	:	2300 NW 195TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-3520
Country	:	US
Telephone Number	:	405-314-7174
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 NW 195TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-3520
Country	:	US
Telephone Number	:	405-314-7174
Fax Number	:

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

Provider Enumeration Date	:	08/21/2021
Last Update Date	:	08/21/2021

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Directions to “ VICTORIA CHAVEZ ” Practice Location

Language	Start Address	Practice Location

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