MEDICARE: ALFREDO CHAVIRA BCBA

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	103K00000X	Behavior Analyst	1-15-20026	TX

General Provider Information

NPI Number	:	1245683796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFREDO CHAVIRA BCBA

Provider Business Mailing Address
First Line	:	505 N BRAND BLVD STE 1000
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-3924
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	611 GATEWAY BLVD STE 120
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-7066
Country	:	US
Telephone Number	:	915-342-4142
Fax Number	:

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	04/19/2021

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