Healthcare Provider Details

I. General information

NPI: 1134352628
Provider Name (Legal Business Name): MARY ELIZABETH CHAVEZ BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA CHAVEZ BS

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 2ND ST NW
ALBUQUERQUE NM
87102-2218
US

IV. Provider business mailing address

1120 2ND ST NW
ALBUQUERQUE NM
87102-2218
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax: 505-248-1351
Mailing address:
  • Phone: 505-764-8231
  • Fax: 505-248-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: