MEDICARE: DR. RICK CHAVEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	G43878	CA
2	208VP0014X	Interventional Pain Medicine Physician	G43878	CA

General Provider Information

NPI Number	:	1144271495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICK CHAVEZ MD

Provider Business Mailing Address
First Line	:	510 N PROSPECT AVE
Second Line	:	SUITE 209
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3028
Country	:	US
Telephone Number	:	310-798-1633
Fax Number	:	310-374-1576

Provider Business Practice Location Address
First Line	:	510 N PROSPECT AVE
Second Line	:	SUITE 209
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3028
Country	:	US
Telephone Number	:	310-798-1633
Fax Number	:	310-374-1576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/08/2011

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