Healthcare Provider Details

I. General information

NPI: 1689313595
Provider Name (Legal Business Name): CARLEIGH NIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 PLEASANT HILL RD
PLEASANT HILL CA
94523-2033
US

IV. Provider business mailing address

PO BOX 102858
PASADENA CA
91189-2858
US

V. Phone/Fax

Practice location:
  • Phone: 925-692-5520
  • Fax: 925-692-5572
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA210166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: