Healthcare Provider Details

I. General information

NPI: 1235934571
Provider Name (Legal Business Name): MARIANNA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANNA SAMSON

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 E SAGEBRUSH ST
LITCHFIELD PARK AZ
85340-4934
US

IV. Provider business mailing address

2362 N 138TH AVE
GOODYEAR AZ
85395-2160
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number16235
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: