Provider Demographics
NPI:1003039991
Name:GAVRIN, JEANNE MARIE
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARIE
Last Name:GAVRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 VIEJO ROAD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD.
Practice Address - Street 2:BUILDING 300
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93912
Practice Address - Country:US
Practice Address - Phone:831-796-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556337173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine