Healthcare Provider Details

I. General information

NPI: 1104744119
Provider Name (Legal Business Name): MARY CATHERINE CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY CHAVEZ

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N DILLON ST
LOS ANGELES CA
90026-4619
US

IV. Provider business mailing address

221 N DILLON ST
LOS ANGELES CA
90026-4619
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-6982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95035496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: