Provider Demographics
NPI:1215691894
Name:CHAVEZ, JEANETTE (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 OXFORD ST STE 209
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3122
Mailing Address - Country:US
Mailing Address - Phone:619-691-1662
Mailing Address - Fax:619-839-3718
Practice Address - Street 1:336 OXFORD ST STE 209
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3122
Practice Address - Country:US
Practice Address - Phone:619-691-1662
Practice Address - Fax:619-839-3718
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist