Basic Information
| Provider Information | |||||||||
| NPI: | 1720286891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | LEANN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 YAKIMA AVE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533828540 | ||||||||
| FaxNumber: | 2533828545 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 LOMAS BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871062719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052721476 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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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 | 208600000X | 80929 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A119324 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 6943 | AK | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD2018-0692 | NM | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD60512058 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | MD9848 | 05 | AK | MEDICAID |