Healthcare Provider Details

I. General information

NPI: 1255485744
Provider Name (Legal Business Name): MARY L CAVALIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

IV. Provider business mailing address

21032 STRATHMOOR LN
HUNTINGTON BEACH CA
92646-7334
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-2829
  • Fax:
Mailing address:
  • Phone: 714-968-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 0159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: