Provider Demographics
NPI:1508904160
Name:NIAVEZ, EDWARD D (LVN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:NIAVEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3372 HOLLOWTREE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-1400
Mailing Address - Country:US
Mailing Address - Phone:760-586-4741
Mailing Address - Fax:760-439-6272
Practice Address - Street 1:3372 HOLLOWTREE DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-1400
Practice Address - Country:US
Practice Address - Phone:760-586-4741
Practice Address - Fax:760-439-6272
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222364164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse