Healthcare Provider Details

I. General information

NPI: 1023774593
Provider Name (Legal Business Name): ASHLEY RENAE BIVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LARA

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E COLORADO BLVD
PASADENA CA
91106-1932
US

IV. Provider business mailing address

19796 NORTHCLIFF DR
SANTA CLARITA CA
91351-5706
US

V. Phone/Fax

Practice location:
  • Phone: 888-823-7262
  • Fax:
Mailing address:
  • Phone: 818-336-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: