Provider Demographics
NPI:1154806545
Name:CHAVEZ, CITADEL M (RN)
Entity type:Individual
Prefix:
First Name:CITADEL
Middle Name:M
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST STE 154
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7515
Mailing Address - Country:US
Mailing Address - Phone:559-355-8956
Mailing Address - Fax:559-227-7203
Practice Address - Street 1:5100 N 6TH ST STE 154
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7515
Practice Address - Country:US
Practice Address - Phone:559-355-8956
Practice Address - Fax:559-227-7203
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD5256292OtherDRIVER'S LICENSE