Basic Information
| Provider Information | |||||||||
| NPI: | 1477194652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIVIAN | ||||||||
| FirstName: | ANITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4120 E IRIS AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932929030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599673956 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1055 W HENDERSON AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932571490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597881200 | ||||||||
| FaxNumber: | 5597133717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2019 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.