MEDICARE: JACQUELINE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760347884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE CHAVEZ

Provider Business Mailing Address
First Line	:	211 18TH ST SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-2666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 COPPER AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5352
Country	:	US
Telephone Number	:	505-706-0865
Fax Number	:

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

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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Directions to “ JACQUELINE CHAVEZ ” Practice Location

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