MEDICARE: DOMINICK 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1518832906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINICK CHAVEZ

Provider Business Mailing Address
First Line	:	1848 DANNY GALLEGOS LN
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-4915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 MAXFIELD AVE NE
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-0000
Country	:	US
Telephone Number	:	505-944-6626
Fax Number	:	505-359-3239

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

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	04/16/2026

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Directions to “ DOMINICK CHAVEZ ” Practice Location

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