Healthcare Provider Details

I. General information

NPI: 1134073679
Provider Name (Legal Business Name): CLARVIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16940 HIGHWAY 14
MOJAVE CA
93501-1238
US

IV. Provider business mailing address

16940 HIGHWAY 14
MOJAVE CA
93501-1238
US

V. Phone/Fax

Practice location:
  • Phone: 661-824-5020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. JANINA GUTIERREZ
Title or Position: CASE MANAGER
Credential: CLARVIDA
Phone: 661-824-5020