Provider Demographics
NPI:1720328172
Name:CHAVEZ, SUSAN GARCIA
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GARCIA
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 1:160 W CERRITOS AVE
Mailing Address - Street 2:BLDG 4
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6546
Mailing Address - Country:US
Mailing Address - Phone:714-687-6716
Mailing Address - Fax:
Practice Address - Street 1:160 W CERRITOS AVE
Practice Address - Street 2:BLDG 4
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6546
Practice Address - Country:US
Practice Address - Phone:714-687-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic