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NPI Code Detail

MEDICARE: ELIZABETH CHAVEZ SUDCC II

MEDICARE: ELIZABETH CHAVEZ SUDCC II
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
1101YA0400XAddiction (Substance Use Disorder) Counselor6570CA

General Provider Information

NPI Number : 1619340056
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CHAVEZ SUDCC II
Provider Business Mailing Address
First Line : 12890 QUINTA WAY
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92240-4852
Country : US
Telephone Number : 760-329-2959
Fax Number : 760-329-2953
Provider Business Practice Location Address
First Line : 12890 QUINTA WAY
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92240-4852
Country : US
Telephone Number : 760-329-2959
Fax Number : 760-329-2953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2015
Last Update Date : 10/08/2021

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Directions to “ ELIZABETH CHAVEZ SUDCC II” Practice Location

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