Provider Demographics
NPI:1912591405
Name:RAZO CHAVEZ, ELIAS
Entity type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:
Last Name:RAZO CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ELIAS
Other - Middle Name:
Other - Last Name:RAZO CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2930 INLAND EMPIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4802
Mailing Address - Country:US
Mailing Address - Phone:909-483-5000
Mailing Address - Fax:
Practice Address - Street 1:2930 INLAND EMPIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4802
Practice Address - Country:US
Practice Address - Phone:909-483-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician