Individual
MRS. THERESA CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7218 W RAYMOND ST, PHOENIX, AZ 85043-7626
(623) 478-0572
Mailing address
7218 W RAYMOND ST, PHOENIX, AZ 85043-7626
(623) 478-0572
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
3971
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
992778
AHCCCS ID NUMBER
AZ
Enumeration date
12/01/2006
Last updated
02/25/2011
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