Healthcare Provider Details

I. General information

NPI: 1063344372
Provider Name (Legal Business Name): GERALDINE CHAVIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 BEVERLY BLVD
LOS ANGELES CA
90057-2402
US

IV. Provider business mailing address

9537 AERO DR
PICO RIVERA CA
90660-4703
US

V. Phone/Fax

Practice location:
  • Phone: 213-353-1140
  • Fax: 213-353-1151
Mailing address:
  • Phone: 213-353-1140
  • Fax: 213-353-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1441930526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: