Provider Demographics
NPI:1487294005
Name:CHAVEZ, EVAN
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 VENETIAN WAY SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7236
Mailing Address - Country:US
Mailing Address - Phone:505-610-7020
Mailing Address - Fax:866-848-6905
Practice Address - Street 1:2659 PAN AMERICAN FWY NE STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1648
Practice Address - Country:US
Practice Address - Phone:505-255-1100
Practice Address - Fax:866-848-6905
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician