=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821895871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARDO RAFAEL CHAVEZ MLS (ASCP), MBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3080 BRELAND DR.
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-646-6426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30001
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88003-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-646-6426
-----------------------------------------------------
Fax | 575-646-6428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246QM0706X
-----------------------------------------------------
Taxonomy Name | Medical Technologist
-----------------------------------------------------
License Number | 249997
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 247ZC0005X
-----------------------------------------------------
Taxonomy Name | Clinical Laboratory Director (Non-physician)
-----------------------------------------------------
License Number | 249997
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------