MEDICARE: DESI 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	103K00000X	Behavior Analyst	6319	TX

General Provider Information

NPI Number	:	1841046265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESI CHAVEZ

Provider Business Mailing Address
First Line	:	800 CRYSTAL FALLS PKWY UNIT 8
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-3672
Country	:	US
Telephone Number	:	512-986-7625
Fax Number	:	281-254-7897

Provider Business Practice Location Address
First Line	:	800 CRYSTAL FALLS PKWY UNIT 8
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-3672
Country	:	US
Telephone Number	:	512-986-7625
Fax Number	:	281-254-7897

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

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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Directions to “ DESI CHAVEZ ” Practice Location

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