Healthcare Provider Details

I. General information

NPI: 1285303206
Provider Name (Legal Business Name): ALEJANDRO VICENTE CHAVEZ SUCHILT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 W ADAMS BLVD # 106
LOS ANGELES CA
90018-3515
US

IV. Provider business mailing address

1968 W ADAMS BLVD # 106
LOS ANGELES CA
90018-3515
US

V. Phone/Fax

Practice location:
  • Phone: 323-731-3534
  • Fax: 323-731-5618
Mailing address:
  • Phone: 323-731-3534
  • Fax: 323-731-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: