MEDICARE: MS. CARLA DIANA 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	101Y00000X	Counselor
2	101Y00000X	Counselor	0096141	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437420791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA DIANA CHAVEZ

Provider Business Mailing Address
First Line	:	505 NATIONAL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4319
Country	:	US
Telephone Number	:	505-690-1171
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 KANE DR
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4949
Country	:	US
Telephone Number	:	505-690-1171
Fax Number	:

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

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	08/05/2020

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