Healthcare Provider Details

I. General information

NPI: 1669499588
Provider Name (Legal Business Name): JILL ANN CAVISH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N BROOKHURST ST STE 200
ANAHEIM CA
92801-5229
US

IV. Provider business mailing address

20052 FERNGLEN DR
YORBA LINDA CA
92886-6016
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0750
  • Fax: 714-780-0757
Mailing address:
  • Phone: 714-780-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number333491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: