Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 63238 | NM |
NPI | 1154907400 |
---|---|
Provider Name | Rebecca L Chavez |
First Address | Albuquerque, NM 87108-5153 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2021 |
Last Update Date | 18/03/2021 |