Provider Demographics
NPI:1194115725
Name:CHAVARRIA, LUIS ANTONIO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:CHAVARRIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 GAUCHO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ELIZARIO
Mailing Address - State:TX
Mailing Address - Zip Code:79849-8904
Mailing Address - Country:US
Mailing Address - Phone:915-383-4001
Mailing Address - Fax:
Practice Address - Street 1:1331 GAUCHO RD
Practice Address - Street 2:
Practice Address - City:SAN ELIZARIO
Practice Address - State:TX
Practice Address - Zip Code:79849-8904
Practice Address - Country:US
Practice Address - Phone:915-383-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist