Provider Demographics
NPI:1689410979
Name:CHAVEZ, TIMOTHY VINCENT
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:VINCENT
Last Name:CHAVEZ
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 1:2625 TOWNSGATE RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5751
Mailing Address - Country:US
Mailing Address - Phone:805-413-3009
Mailing Address - Fax:
Practice Address - Street 1:2625 TOWNSGATE RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5751
Practice Address - Country:US
Practice Address - Phone:805-422-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician