Provider Demographics
NPI:1083145635
Name:DECLET, DAISY (LVN)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:DECLET
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 VIDA DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0122
Mailing Address - Country:US
Mailing Address - Phone:805-890-9576
Mailing Address - Fax:
Practice Address - Street 1:1434 VIDA DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0122
Practice Address - Country:US
Practice Address - Phone:805-890-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279178164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse