Healthcare Provider Details

I. General information

NPI: 1275823783
Provider Name (Legal Business Name): JULIANA BERNADETTE CHAVEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WILLIAM ST SE
ALBUQUERQUE NM
87102-4661
US

IV. Provider business mailing address

1401 WILLIAM STREET SE
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-768-5450
  • Fax: 505-842-1185
Mailing address:
  • Phone: 505-768-5450
  • Fax: 505-842-1185

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 StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2013-0833
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: