Provider Demographics
NPI:1285831149
Name:MATHEWS, CEAZANNE LOUISE (LVN)
Entity Type:Individual
Prefix:
First Name:CEAZANNE
Middle Name:LOUISE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CEAZANNE
Other - Middle Name:LOUISE
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:28999 OLD TOWN FRONT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2842
Mailing Address - Country:US
Mailing Address - Phone:951-261-8392
Mailing Address - Fax:310-576-1027
Practice Address - Street 1:28999 OLD TOWN FRONT ST STE 104
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2842
Practice Address - Country:US
Practice Address - Phone:951-261-8392
Practice Address - Fax:310-576-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291923164X00000X
225400000X
CAVN271923164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner