Healthcare Provider Details

I. General information

NPI: 1750216172
Provider Name (Legal Business Name): CLARVIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E ORANGETHORPE AVE STE 200
FULLERTON CA
92831-5205
US

IV. Provider business mailing address

1501 E ORANGETHORPE AVE STE 200
FULLERTON CA
92831-5205
US

V. Phone/Fax

Practice location:
  • Phone: 714-254-8473
  • Fax: 714-254-8480
Mailing address:
  • Phone: 714-254-8473
  • Fax: 714-254-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: LENA THONGDARA
Title or Position: INTERN
Credential:
Phone: 714-254-8473