Provider Demographics
NPI:1730065996
Name:CHAVEZ, EDA G
Entity type:Individual
Prefix:
First Name:EDA
Middle Name:G
Last Name:CHAVEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 HEACOCK ST
Mailing Address - Street 2:C224
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553
Mailing Address - Country:US
Mailing Address - Phone:562-774-7145
Mailing Address - Fax:
Practice Address - Street 1:13400 HEACOCK ST
Practice Address - Street 2:C224
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:562-774-7145
Practice Address - Fax:562-774-7145
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator