Healthcare Provider Details

I. General information

NPI: 1548890940
Provider Name (Legal Business Name): MEGAN CLAIRE CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 CORRALES RD STE 210
CORRALES NM
87048-9347
US

IV. Provider business mailing address

3949 CORRALES RD STE 210
CORRALES NM
87048-9347
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-2474
  • Fax: 505-899-8172
Mailing address:
  • Phone: 505-898-2474
  • Fax: 505-899-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD0930
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: