Provider Demographics
NPI:1629356647
Name:CHAVEZ-ABRAHAM, VICTOR S (SA-C,RN)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:S
Last Name:CHAVEZ-ABRAHAM
Suffix:
Gender:M
Credentials:SA-C,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 TIMBER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6956
Mailing Address - Country:US
Mailing Address - Phone:303-587-7121
Mailing Address - Fax:303-734-2291
Practice Address - Street 1:11000 TIMBER RIDGE LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-6956
Practice Address - Country:US
Practice Address - Phone:303-587-7121
Practice Address - Fax:303-734-2291
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0001276246ZC0007X
CORN.0200006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163W00000XNursing Service ProvidersRegistered Nurse