Healthcare Provider Details

I. General information

NPI: 1942130042
Provider Name (Legal Business Name): JUSHONA CAVINESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44020 KIRKLAND AVE
LANCASTER CA
93535-3631
US

IV. Provider business mailing address

44020 KIRKLAND AVE
LANCASTER CA
93535-3631
US

V. Phone/Fax

Practice location:
  • Phone: 661-703-2100
  • Fax:
Mailing address:
  • Phone: 661-703-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberCPT-02136751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: