Provider Demographics
NPI:1679778732
Name:PAIGE, DAVID J (LVN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:PAIGE
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 1:16712 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2009
Mailing Address - Country:US
Mailing Address - Phone:909-684-6366
Mailing Address - Fax:
Practice Address - Street 1:1505 CANTERBURY CIR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2162
Practice Address - Country:US
Practice Address - Phone:909-335-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171224164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse