Healthcare Provider Details

I. General information

NPI: 1639698491
Provider Name (Legal Business Name): ADRIAN ALEJANDRO CHAVEZ BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SUNSET BLVD, 5TH FLOOR DIVISION OF ADOLESCENT AND YOUNG ADULT MEDICINE, #2
LOS ANGELES CA
90027
US

IV. Provider business mailing address

5000 W SUNSET BLVD FL 5
LOS ANGELES CA
90027-5861
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-7512
  • Fax:
Mailing address:
  • Phone: 323-361-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: