Provider Demographics
NPI:1720127392
Name:KAVIANIAN, NANCY (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KAVIANIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:760-767-4552
Practice Address - Street 1:69175 RAMON RD BLDG A
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3344
Practice Address - Country:US
Practice Address - Phone:760-321-6776
Practice Address - Fax:760-321-4036
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7747363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAKAV104305075OtherNCC ID
CARN353978OtherRN LICENSE