Provider Demographics
NPI:1205712130
Name:CHAVEZ, AUDRIANA C
Entity type:Individual
Prefix:
First Name:AUDRIANA
Middle Name:C
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 1:601 BALER LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6284
Mailing Address - Country:US
Mailing Address - Phone:505-263-5245
Mailing Address - Fax:
Practice Address - Street 1:172 WILLOW RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6060
Practice Address - Country:US
Practice Address - Phone:505-403-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide