Healthcare Provider Details

I. General information

NPI: 1164139499
Provider Name (Legal Business Name): MR. MARCELO CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

831 E ARROW HWY
POMONA CA
91767-2535
US

V. Phone/Fax

Practice location:
  • Phone: 909-398-4383
  • Fax: 909-445-8936
Mailing address:
  • Phone: 909-398-4383
  • Fax: 909-445-8936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number139821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: