Healthcare Provider Details

I. General information

NPI: 1417977059
Provider Name (Legal Business Name): DON J. CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 S SAINT FRANCIS DR SUITE E
SANTA FE NM
87505-4032
US

IV. Provider business mailing address

865 CAMINO CONSUELO
SANTA FE NM
87507-5034
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number9585
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-04730
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: