Healthcare Provider Details

I. General information

NPI: 1720997992
Provider Name (Legal Business Name): VITEVA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E HERNDON AVE, SUITE 200
CLOVIS CA
93611
US

IV. Provider business mailing address

1776 N RENN AVE
CLOVIS CA
93619-8148
US

V. Phone/Fax

Practice location:
  • Phone: 954-512-3338
  • Fax:
Mailing address:
  • Phone: 954-512-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SAMIA GHAFFAR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 559-246-5040