Basic Information
| Provider Information | |||||||||
| NPI: | 1790177202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVARRO | ||||||||
| FirstName: | FREDDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1551 FORUM PL | ||||||||
| Address2: | 400 D&E | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617126821 | ||||||||
| FaxNumber: | 5617128070 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 SW STERRET CIR | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349533325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7726266847 | ||||||||
| FaxNumber: | 5617128070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2015 | ||||||||
| LastUpdateDate: | 02/21/2015 | ||||||||
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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 | 171M00000X | FL | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.