Healthcare Provider Details

I. General information

NPI: 1821614694
Provider Name (Legal Business Name): ELIZABETH JANET CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date: 12/17/2021
Reactivation Date: 11/16/2022

III. Provider practice location address

5850 THILLE ST STE 105
VENTURA CA
93003-5494
US

IV. Provider business mailing address

5850 THILLE ST STE 105
VENTURA CA
93003-5494
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133970
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: