Healthcare Provider Details

I. General information

NPI: 1992430144
Provider Name (Legal Business Name): NISHA JUVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR # H3441
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

142 COLUMBINE DR
HERCULES CA
94547-1006
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: