Provider Demographics
NPI:1154600971
Name:CHAVEZ, CENOBIO (ATP)
Entity type:Individual
Prefix:MR
First Name:CENOBIO
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 N. MESA
Mailing Address - Street 2:217
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3523
Mailing Address - Country:US
Mailing Address - Phone:915-833-2272
Mailing Address - Fax:915-833-2275
Practice Address - Street 1:7500 N MESA ST
Practice Address - Street 2:217
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3501
Practice Address - Country:US
Practice Address - Phone:915-833-2272
Practice Address - Fax:915-833-2275
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
TX218741107332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7442560001Medicare NSC