Provider Demographics
NPI:1457593535
Name:GARVIN, RONALD JOHN (LVN)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:GARVIN
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 1:2763 WISSEMANN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3652
Mailing Address - Country:US
Mailing Address - Phone:916-381-3485
Mailing Address - Fax:
Practice Address - Street 1:2763 WISSEMANN DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3652
Practice Address - Country:US
Practice Address - Phone:916-381-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN143874164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse