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General NPI Number Information
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NPI Number | 1922257096
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Entity Type | Organization
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Legal Business Name | CHAVEZ JO INTERNAL MEDICINE P.A.
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 1636 N CENTRAL AVE SUITE 100
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City | SEBASTIAN
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State | FL
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Zip | 32958-3808
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Country | US
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Telephone | 772-388-9066
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Fax | 772-388-9067
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Provider Business Mailing Address
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Address Line | 1636 N CENTRAL AVE SUITE 100
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City | SEBASTIAN
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State | FL
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Zip | 32958-3808
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Country | US
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Telephone | 772-388-9066
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Fax | 772-388-9067
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. KATIUSCA CHAVEZ
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Credential | M.D.
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Telephone | 772-388-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 102747
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License Number State | FL
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