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General NPI Number Information
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NPI Number | 1356047260
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Entity Type | Individual
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Provider Name | TERESA DE JESUS CHAVARIN
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Gender | Female
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 9660 HAVEN AVE STE 203
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5897
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Country | US
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Telephone | 951-428-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 9660 HAVEN AVE STE 203
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5897
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Country | US
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Telephone | 951-428-0085
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW110817
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License Number State | CA
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