Healthcare Provider Details

I. General information

NPI: 1497120810
Provider Name (Legal Business Name): MICHAEL ANTHONY CHAVEZ APCC, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S CITRUS AVE
AZUSA CA
91702-5932
US

IV. Provider business mailing address

546 S CITRUS AVE
AZUSA CA
91702-5932
US

V. Phone/Fax

Practice location:
  • Phone: 626-852-8300
  • Fax:
Mailing address:
  • Phone: 626-852-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: