Basic Information
| Provider Information | |||||||||
| NPI: | 1639482219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVARRIA | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | ASLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 URAL WAY | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799072617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174330721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6601 MONTANA AVE | ||||||||
| Address2: | SUITE G & H | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799252155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158387604 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2010 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 35566 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 149984001 | 05 | TX | MEDICAID |