Basic Information
| Provider Information | |||||||||
| NPI: | 1316101124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | MARILU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26666 | ||||||||
| Address2: | PHS PROVIDER ENROLLMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059236770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1436 WILLIAMSBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467595453 | ||||||||
| FaxNumber: | 6463744940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | S7405 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2011-0563 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 58349 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.140675 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 812 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 279186-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.