Healthcare Provider Details

I. General information

NPI: 1699438358
Provider Name (Legal Business Name): ABHIJISHYO JANA LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

IV. Provider business mailing address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

V. Phone/Fax

Practice location:
  • Phone: 408-379-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE172515
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number736047
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: