MEDICARE: MAYRA R 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	225700000X	Massage Therapist	92921	CA

General Provider Information

NPI Number	:	1447013305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA R CHAVEZ

Provider Business Mailing Address
First Line	:	4244 E GRAND AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-4053
Country	:	US
Telephone Number	:	909-545-2176
Fax Number	:

Provider Business Practice Location Address
First Line	:	15911 POMONA RINCON RD
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5566
Country	:	US
Telephone Number	:	909-248-1155
Fax Number	:

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

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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