Healthcare Provider Details

I. General information

NPI: 1679956163
Provider Name (Legal Business Name): OCTAVIO CHAVEZ HERBAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 S FALKENBURG RD STE 201
RIVERVIEW FL
33578-2594
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-0030
  • Fax:
Mailing address:
  • Phone: 480-480-8330
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME144059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: