Provider Demographics
NPI:1871705988
Name:CLAVIN, VICKI MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:MARIE
Last Name:CLAVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36280 HAGUE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9273
Mailing Address - Country:US
Mailing Address - Phone:951-926-8491
Mailing Address - Fax:951-926-0889
Practice Address - Street 1:36280 HAGUE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9273
Practice Address - Country:US
Practice Address - Phone:951-926-8491
Practice Address - Fax:951-926-0889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN001490OtherMEDI-CAL FAMILY TRAINING
CAEPS011920OtherMEDI-CAL PROVIDER NUMBER