Basic Information
| Provider Information | |||||||||
| NPI: | 1730250887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | LEIVI | ||||||||
| MiddleName: | ESEQUIEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 W PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930011844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055634885 | ||||||||
| FaxNumber: | 8055690413 | ||||||||
| Practice Location | |||||||||
| Address1: | 1722 S LEWIS RD | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930128520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052162358 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | 3930 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.