Healthcare Provider Details

I. General information

NPI: 1720394083
Provider Name (Legal Business Name): LAURA CHAVEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136
US

IV. Provider business mailing address

719 SW 10TH ST
HALLANDALE BEACH FL
33009-6946
US

V. Phone/Fax

Practice location:
  • Phone: 305-469-3157
  • Fax:
Mailing address:
  • Phone: 305-469-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME116716
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME116716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: