Healthcare Provider Details

I. General information

NPI: 1669333035
Provider Name (Legal Business Name): ADRIANA M CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 S EASTERN AVE
HENDERSON NV
89052-5574
US

IV. Provider business mailing address

6549 BOURBON WAY
LAS VEGAS NV
89107-3330
US

V. Phone/Fax

Practice location:
  • Phone: 760-856-0607
  • Fax:
Mailing address:
  • Phone: 702-945-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: