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1992217764
KENNETH THEODORE CHAVEZ
PASADENA, CA
NPI
1992217764
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-11-01
Last Update Date
2017-11-01
Business Address
KENNETH THEODORE CHAVEZ
225 GRANDVIEW ST
PASADENA, CA 91104-2114
Phone number: 626-797-1124
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Mailing Address
KENNETH THEODORE CHAVEZ
225 GRANDVIEW ST
PASADENA, CA 91104-2114
Phone number: 626-797-1124
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