Provider Demographics
NPI:1386472710
Name:ORTIZ CHAVES, MARIANELA (HMA, MHA)
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:ORTIZ CHAVES
Suffix:
Gender:F
Credentials:HMA, MHA
Other - Prefix:
Other - First Name:MARIANELA
Other - Middle Name:
Other - Last Name:ORTIZ -CHAVES DAHLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HMA, MHA
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95052-0251
Mailing Address - Country:US
Mailing Address - Phone:408-896-3215
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 251
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95052-0251
Practice Address - Country:US
Practice Address - Phone:408-896-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56-859156174H00000X, 208M00000X, 390200000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No174H00000XOther Service ProvidersHealth Educator
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program