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General NPI Number Information
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NPI Number | 1265173884
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Entity Type | Individual
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Provider Name | MIREYA CHAVEZ-MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 205 GLADYS FEWOX RD
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City | MULBERRY
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State | FL
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Zip | 33860-8566
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Country | US
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Telephone | 863-804-5849
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Fax |
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Provider Business Mailing Address
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Address Line | 315 E POINTE LN APT 721
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City | EAST LANSING
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State | MI
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Zip | 48823-1208
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Country | US
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Telephone | 863-804-5849
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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