Healthcare Provider Details

I. General information

NPI: 1316800097
Provider Name (Legal Business Name): MARISSA CHAVEZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29141 VALLEJO AVE
TEMECULA CA
92592-2319
US

IV. Provider business mailing address

1011 BLUEFISH PL
NEW BERN NC
28562-0400
US

V. Phone/Fax

Practice location:
  • Phone: 760-421-2085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250009416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: