Individual
KELLY CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1625 N 39TH AVE, PHOENIX, AZ 85009-2149
(602) 233-0017
Mailing address
1625 N 39TH AVE, PHOENIX, AZ 85009-2149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
243687
AZ
Other
Enumeration date
07/06/2020
Last updated
10/22/2020
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