Healthcare Provider Details

I. General information

NPI: 1407421621
Provider Name (Legal Business Name): LAURA CHAVEZ ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 30TH ST
SAN DIEGO CA
92154-3421
US

IV. Provider business mailing address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

V. Phone/Fax

Practice location:
  • Phone: 619-565-2650
  • Fax:
Mailing address:
  • Phone: 619-683-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW131654
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: