| Dianachavez, Llc | |
|
505 National Ave Ste 2 Las Vegas NM 87701-4353 | |
| (505) 690-1171 | |
| Not Available |
| Full Name | Dianachavez, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 505 National Ave Ste 2, Las Vegas, New Mexico |
| Authorized Official Name and Position | Carla Diana Chavez (COUNSELOR) |
| Authorized Official Contact | 5056901171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dianachavez, Llc Po Box 754 Las Vegas NM 87701-0754 Ph: (505) 690-1171 | Dianachavez, Llc 505 National Ave Ste 2 Las Vegas NM 87701-4353 Ph: (505) 690-1171 |
| NPI Number | 1235756727 |
|---|---|
| Provider Enumeration Date | 06/30/2020 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235756727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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