Provider Demographics
NPI:1053981399
Name:GONZALEZ CHAVIRA, MOISES ALAN
Entity type:Individual
Prefix:
First Name:MOISES
Middle Name:ALAN
Last Name:GONZALEZ CHAVIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 YESLER WAY
Mailing Address - Street 2:#1110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-229-3404
Mailing Address - Fax:
Practice Address - Street 1:201 YESLER WAY
Practice Address - Street 2:#1110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-229-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA12234171R00000X
WAMC53840171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter