Healthcare Provider Details

I. General information

NPI: 1053744094
Provider Name (Legal Business Name): JULIUS LLAVORE LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JOSE FIGUERES AVE
SAN JOSE CA
95116-2022
US

IV. Provider business mailing address

101 JOSE FIGUERES AVE
SAN JOSE CA
95116-2022
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-3120
  • Fax: 408-347-3121
Mailing address:
  • Phone: 408-347-3120
  • Fax: 408-347-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN233097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: