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NPI Code Detail

MEDICARE: MARY JANE CHAVEZ CHW

MEDICARE: MARY JANE CHAVEZ CHW
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
1172V00000XCommunity Health WorkerNM

General Provider Information

NPI Number : 1396587820
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JANE CHAVEZ CHW
Provider Business Mailing Address
First Line : 117 CAMINO DE VIDA STE 300
Second Line :
City : SANTA ROSA
State : NM
Zip : 88435-2267
Country : US
Telephone Number : 575-472-4311
Fax Number : 877-651-0289
Provider Business Practice Location Address
First Line : 717 S 3RD ST
Second Line :
City : SANTA ROSA
State : NM
Zip : 88435-2411
Country : US
Telephone Number : 575-472-8032
Fax Number : 877-651-0289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2024
Last Update Date : 06/06/2024

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Directions to “ MARY JANE CHAVEZ CHW” Practice Location

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