Provider Demographics
NPI:1881279057
Name:SALDIVAR, MICHELLE (LVN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SALDIVAR
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 1:2700 PETERSON PL APT 14A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5305
Mailing Address - Country:US
Mailing Address - Phone:949-339-7606
Mailing Address - Fax:
Practice Address - Street 1:2400 E KATELLA AVE STE 800
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5955
Practice Address - Country:US
Practice Address - Phone:714-714-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN715691164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse