Healthcare Provider Details

I. General information

NPI: 1013511450
Provider Name (Legal Business Name): ROSALINDA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 N CALLE EMPALME
NOGALES AZ
85621-3346
US

IV. Provider business mailing address

PO BOX 86537
TUCSON AZ
85754-6537
US

V. Phone/Fax

Practice location:
  • Phone: 520-975-7005
  • Fax: 520-407-5398
Mailing address:
  • Phone: 520-721-1887
  • Fax: 520-407-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number8477574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: