1578760062 NPI number — MS. MICHELE ANTOINETTE CHAVES MFTI

Table of content: MS. MICHELE ANTOINETTE CHAVES MFTI (NPI 1578760062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578760062 NPI number — MS. MICHELE ANTOINETTE CHAVES MFTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAVES
Provider First Name:
MICHELE
Provider Middle Name:
ANTOINETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFTI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAVES
Provider Other First Name:
MICHELE
Provider Other Middle Name:
ANTOINETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFTI 52462
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1578760062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2261 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94559-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-253-4711
Provider Business Mailing Address Fax Number:
707-251-1070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2261 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94559-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-253-4711
Provider Business Practice Location Address Fax Number:
707-251-1070
Provider Enumeration Date:
06/28/2007

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: 101YM0800X , with the licence number:  MFTI 52462 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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