Provider Demographics
NPI:1609921634
Name:BIVINS, MAUREENA (LAC)
Entity Type:Individual
Prefix:
First Name:MAUREENA
Middle Name:
Last Name:BIVINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31255 CEDAR VALLEY DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4014
Mailing Address - Country:US
Mailing Address - Phone:818-991-2600
Mailing Address - Fax:805-529-7388
Practice Address - Street 1:31255 CEDAR VALLEY DR
Practice Address - Street 2:SUITE 307
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4014
Practice Address - Country:US
Practice Address - Phone:818-991-2600
Practice Address - Fax:805-529-7388
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist