Healthcare Provider Details

I. General information

NPI: 1891621892
Provider Name (Legal Business Name): PROVIDENT VISION NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 HOLLOW RIDGE CT
ANTIOCH CA
94531-8074
US

IV. Provider business mailing address

4464 LONE TREE WAY STE 604
ANTIOCH CA
94531-7413
US

V. Phone/Fax

Practice location:
  • Phone: 925-525-0600
  • Fax: 925-525-0600
Mailing address:
  • Phone: 925-565-0600
  • Fax: 925-565-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RHONDA JONES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 925-565-0600