MEDICARE: TRISHELLE JENA 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1295665982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHELLE JENA CHAVEZ

Provider Business Mailing Address
First Line	:	321 HUMMINGBIRD LN
Second Line	:
City	:	ALGODONES
State	:	NM
Zip	:	87001-8224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2754 AGUA FRIA ST STE I
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5506
Country	:	US
Telephone Number	:	505-690-3134
Fax Number	:

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ TRISHELLE JENA CHAVEZ ” Practice Location

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