Provider Demographics
NPI:1942855978
Name:HARVEY, SHAUN XAVIER
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:XAVIER
Last Name:HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28401 LOS ALISOS BLVD APT 2207
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5953
Mailing Address - Country:US
Mailing Address - Phone:714-342-3341
Mailing Address - Fax:949-215-7604
Practice Address - Street 1:28401 LOS ALISOS BLVD APT 6102
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5956
Practice Address - Country:US
Practice Address - Phone:714-310-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherN/A