Healthcare Provider Details

I. General information

NPI: 1932788791
Provider Name (Legal Business Name): BIANCA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S HIGLEY RD STE 104
GILBERT AZ
85296-5045
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104 PMB 1076
GILBERT AZ
85296-5045
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-1815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-22584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: