Healthcare Provider Details

I. General information

NPI: 1679129225
Provider Name (Legal Business Name): ADRIAN CHAVEZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 W HUNTINGTON DR STE 103
ARCADIA CA
91007-3492
US

IV. Provider business mailing address

PO BOX 90730
PASADENA CA
91109-0730
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-8150
  • Fax: 626-795-7374
Mailing address:
  • Phone: 626-795-8051
  • Fax: 626-795-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT297026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: