Healthcare Provider Details

I. General information

NPI: 1861836728
Provider Name (Legal Business Name): EVA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

IV. Provider business mailing address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-6305
  • Fax: 509-575-3398
Mailing address:
  • Phone: 509-469-6305
  • Fax: 509-575-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23098759
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60683418
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: