Basic Information
| Provider Information | |||||||||
| NPI: | 1205136983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 ALAMO AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871063204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059252409 | ||||||||
| FaxNumber: | 5059252411 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 ALAMO AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871063204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059252409 | ||||||||
| FaxNumber: | 5059252411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L17349 | NM | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.