Basic Information
| Provider Information | |||||||||
| NPI: | 1548817414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | JOSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 S WESTLAKE AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900572906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134839201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1334 LINCOLN BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103146200 | ||||||||
| FaxNumber: | 3104502024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2019 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.