Healthcare Provider Details

I. General information

NPI: 1396195285
Provider Name (Legal Business Name): MATTHEW CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 E GREENWAY PKWY #1115
SCOTTSDALE AZ
85254-2106
US

IV. Provider business mailing address

6735 E GREENWAY PKWY #1115
SCOTTSDALE AZ
85254-2106
US

V. Phone/Fax

Practice location:
  • Phone: 773-242-8397
  • Fax: 866-211-2884
Mailing address:
  • Phone: 773-242-8397
  • Fax: 866-211-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: