Provider Demographics
NPI:1023657459
Name:ROSALES-CHAVEZ, JOHANNA REYNA
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:REYNA
Last Name:ROSALES-CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SLOANE CV
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-9413
Mailing Address - Country:US
Mailing Address - Phone:205-876-5288
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2247
Practice Address - Country:US
Practice Address - Phone:014-489-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program