Healthcare Provider Details

I. General information

NPI: 1174061873
Provider Name (Legal Business Name): RYAN ALEC CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

PO BOX 680060
FRANKLIN TN
37068-0060
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-7455
  • Fax:
Mailing address:
  • Phone: 629-235-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01468
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: