1174497853 NPI number — MS. JENNIFER CHAVEZ M.A. ED., P.P.S.

Table of content: MS. JENNIFER CHAVEZ M.A. ED., P.P.S. (NPI 1174497853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174497853 NPI number — MS. JENNIFER CHAVEZ M.A. ED., P.P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAVEZ
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. ED., P.P.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174497853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25631 PETER A HARTMAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-568-1234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23882 LANDISVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630-5152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-837-2260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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