Provider Demographics
NPI:1770835696
Name:OATES, ALIYAH R (LVN)
Entity Type:Individual
Prefix:
First Name:ALIYAH
Middle Name:R
Last Name:OATES
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 1:3919 N CARRUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-2002
Mailing Address - Country:US
Mailing Address - Phone:559-492-1768
Mailing Address - Fax:
Practice Address - Street 1:3919 N CARRUTH AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-2002
Practice Address - Country:US
Practice Address - Phone:559-492-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN238036313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility