Provider Demographics
NPI:1144271495
Name:CHAVEZ, RICK (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N PROSPECT AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3028
Mailing Address - Country:US
Mailing Address - Phone:310-798-1633
Mailing Address - Fax:310-374-1576
Practice Address - Street 1:510 N PROSPECT AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3028
Practice Address - Country:US
Practice Address - Phone:310-798-1633
Practice Address - Fax:310-374-1576
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43878208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG43878XMedicare ID - Type Unspecified
A49488Medicare UPIN