Healthcare Provider Details

I. General information

NPI: 1740232990
Provider Name (Legal Business Name): MARY ANN FLAVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

2890 ATASCADERO RD
MORRO BAY CA
93442-1869
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0900
  • Fax: 559-733-6861
Mailing address:
  • Phone: 805-712-6161
  • Fax: 805-357-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC33843
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC33843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: