Healthcare Provider Details

I. General information

NPI: 1790646255
Provider Name (Legal Business Name): MAURICE CHAVEZ NTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE STE 19
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

PO BOX 665
LOS LUNAS NM
87031-0665
US

V. Phone/Fax

Practice location:
  • Phone: 505-315-1095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT4447
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: