Basic Information
| Provider Information | |||||||||
| NPI: | 1124584743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | SENDI | ||||||||
| MiddleName: | YADIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 E COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911062327 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 12432 BELLFLOWER BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902422806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182416780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2019 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y9160980 | CA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | Y |
No ID Information.