Provider Demographics
NPI:1447871769
Name:LAVIN, JAMES ERIC (HIS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:LAVIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W 24TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8351
Mailing Address - Country:US
Mailing Address - Phone:928-344-1968
Mailing Address - Fax:928-344-1968
Practice Address - Street 1:1025 W 24TH ST STE 1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8351
Practice Address - Country:US
Practice Address - Phone:928-344-1968
Practice Address - Fax:928-344-1968
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ASHADE11092237700000X
AZHADE11092237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist