MEDICARE: CLARISSA 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639914369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA CHAVEZ

Provider Business Mailing Address
First Line	:	5198 ARLINGTON AVE STE 211
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2603
Country	:	US
Telephone Number	:	562-338-7157
Fax Number	:

Provider Business Practice Location Address
First Line	:	5198 ARLINGTON AVE STE 211
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2603
Country	:	US
Telephone Number	:	562-338-7157
Fax Number	:

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

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	07/03/2024

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Directions to “ CLARISSA CHAVEZ ” Practice Location

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