Healthcare Provider Details

I. General information

NPI: 1770022642
Provider Name (Legal Business Name): LORENZO CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date: 12/02/2021
Reactivation Date: 06/29/2022

III. Provider practice location address

381 4TH AVE.
BETHEL AK
99559-3227
US

IV. Provider business mailing address

4003 MINNESOTA DR APT 20
ANCHORAGE AK
99503-6453
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-2242
  • Fax: 907-543-1481
Mailing address:
  • Phone: 907-545-7726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: