Provider Demographics
NPI:1831915529
Name:HARDIN, H LAVERNE LAVERNE
Entity type:Individual
Prefix:
First Name:H LAVERNE
Middle Name:LAVERNE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:LAVERNE
Other - Last Name:HARDN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1498 N SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2752
Mailing Address - Country:US
Mailing Address - Phone:909-455-7248
Mailing Address - Fax:866-799-4635
Practice Address - Street 1:9240 19TH ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-4835
Practice Address - Country:US
Practice Address - Phone:909-455-7248
Practice Address - Fax:866-799-4635
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No374U00000XNursing Service Related ProvidersHome Health Aide