Healthcare Provider Details

I. General information

NPI: 1043588049
Provider Name (Legal Business Name): CARI ANN CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N SKY LOOP
ROSWELL NM
88201-8302
US

IV. Provider business mailing address

45 N SKY LOOP
ROSWELL NM
88201-8302
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-8323
  • Fax:
Mailing address:
  • Phone: 575-208-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05554
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: