Healthcare Provider Details

I. General information

NPI: 1043976046
Provider Name (Legal Business Name): ALEXANDER CHAVEZ-SILES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 E 4TH ST STE 101
SANTA ANA CA
92701-5159
US

IV. Provider business mailing address

12728 LINNELL AVE
GARDEN GROVE CA
92843-4212
US

V. Phone/Fax

Practice location:
  • Phone: 714-525-8509
  • Fax:
Mailing address:
  • Phone: 714-588-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number155855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: