Provider Demographics
NPI:1134352628
Name:CHAVEZ, MARY ELIZABETH (BS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:CHAVEZ
Suffix:
Gender:
Credentials:BS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:1120 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2218
Mailing Address - Country:US
Mailing Address - Phone:505-764-8231
Mailing Address - Fax:505-248-1351
Practice Address - Street 1:1120 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2218
Practice Address - Country:US
Practice Address - Phone:505-764-8231
Practice Address - Fax:505-248-1351
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator