Healthcare Provider Details

I. General information

NPI: 1669359832
Provider Name (Legal Business Name): MARIELLE KARYNA CHAVEZ CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 CURIE DR STE 103
EL PASO TX
79902-2909
US

IV. Provider business mailing address

3124 RED MAPLE DR
EL PASO TX
79938-4592
US

V. Phone/Fax

Practice location:
  • Phone: 915-532-2985
  • Fax:
Mailing address:
  • Phone: 915-228-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1205200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: