Healthcare Provider Details

I. General information

NPI: 1437355773
Provider Name (Legal Business Name): HEATHER A PRATT-CHAVEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2007
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE 3 ACC
ALBUQUERQUE NM
87106-2745
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2345
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRS20070350
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: