Healthcare Provider Details

I. General information

NPI: 1285831149
Provider Name (Legal Business Name): CEAZANNE LOUISE MATHEWS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CEAZANNE LOUISE MATHEWS

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 COUNTY FARM RD
RIVERSIDE CA
92503-3507
US

IV. Provider business mailing address

18612 SANTA ANA AVE
BLOOMINGTON CA
92316-2639
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-7120
  • Fax:
Mailing address:
  • Phone: 909-421-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN271923
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number291923
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: