MEDICARE: SANDRA ANGELICA CHAVEZ NP

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	363LG0600X	Gerontology Nurse Practitioner	1076073	TX

General Provider Information

NPI Number	:	1780321059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA ANGELICA CHAVEZ NP

Provider Business Mailing Address
First Line	:	18333 EGRET BAY BLVD STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3239
Country	:	US
Telephone Number	:	281-332-3001
Fax Number	:	281-332-3005

Provider Business Practice Location Address
First Line	:	18333 EGRET BAY BLVD STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-332-3001
Fax Number	:

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

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	03/11/2026

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