MEDICARE: LANI RENEE LYNN CHAVEZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1275286833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANI RENEE LYNN CHAVEZ

Provider Business Mailing Address
First Line	:	36947 COOK ST STE 104
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6078
Country	:	US
Telephone Number	:	760-354-8285
Fax Number	:

Provider Business Practice Location Address
First Line	:	36947 COOK ST STE 104
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6078
Country	:	US
Telephone Number	:	760-354-8285
Fax Number	:

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

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/02/2022

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