Healthcare Provider Details

I. General information

NPI: 1083986285
Provider Name (Legal Business Name): PEDRO S CHAVEZ-H,M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 N MESA ST
EL PASO TX
79902-4018
US

IV. Provider business mailing address

1517 N MESA ST
EL PASO TX
79902-4018
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-0269
  • Fax: 915-542-0413
Mailing address:
  • Phone: 915-533-0269
  • Fax: 915-542-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD7030
License Number StateTX

VIII. Authorized Official

Name: MRS. JOSEFINA MOLINA
Title or Position: OFFICE MANAGER
Credential:
Phone: 915-533-0269