Provider Demographics
NPI:1851974042
Name:ROVNEY, JEFFERY T (LVN)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:T
Last Name:ROVNEY
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 1:91 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-6514
Mailing Address - Country:US
Mailing Address - Phone:949-899-3206
Mailing Address - Fax:
Practice Address - Street 1:10960 POPPY FIELD CIR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-3912
Practice Address - Country:US
Practice Address - Phone:949-899-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690690164X00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No164X00000XNursing Service ProvidersLicensed Vocational Nurse