Provider Demographics
NPI:1740530823
Name:HUARACHA, ELVIA (LVN)
Entity type:Individual
Prefix:
First Name:ELVIA
Middle Name:
Last Name:HUARACHA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5124
Mailing Address - Country:US
Mailing Address - Phone:559-287-2910
Mailing Address - Fax:
Practice Address - Street 1:1771 GRIFFITH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-5124
Practice Address - Country:US
Practice Address - Phone:559-287-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN257514164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse