Individual
MS. CARLA DIANA CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
706 KANE DR, LAS VEGAS, NM 87701-4949
(505) 690-1171
Mailing address
505 NATIONAL AVE, LAS VEGAS, NM 87701-4319
(505) 690-1171
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0096141
NM
101Y00000X
Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33786569
—
NM
Enumeration date
01/18/2012
Last updated
08/05/2020
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