Provider Demographics
NPI:1285780650
Name:CHAVEZ, MARIA LUZ
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUZ
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MINCEY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-6227
Mailing Address - Country:US
Mailing Address - Phone:678-897-1387
Mailing Address - Fax:
Practice Address - Street 1:4222 MCEVER RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2237
Practice Address - Country:US
Practice Address - Phone:770-536-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA250100103031343183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician