Provider Demographics
NPI:1215717541
Name:CHAVEZ & MEDEROS LLC
Entity type:Organization
Organization Name:CHAVEZ & MEDEROS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REYSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MSC-APRN-FNP-C
Authorized Official - Phone:702-772-7705
Mailing Address - Street 1:4415 HAWTHORNE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4605
Mailing Address - Country:US
Mailing Address - Phone:702-772-7705
Mailing Address - Fax:
Practice Address - Street 1:4415 HAWTHORNE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4605
Practice Address - Country:US
Practice Address - Phone:702-772-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty