Healthcare Provider Details

I. General information

NPI: 1801132220
Provider Name (Legal Business Name): DENA LEVARI IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W CASABLANCA AVE
CLOVIS NM
88103-5009
US

IV. Provider business mailing address

208 W CASABLANCA AVE
CLOVIS NM
88103-5009
US

V. Phone/Fax

Practice location:
  • Phone: 575-791-9712
  • Fax: 575-784-2124
Mailing address:
  • Phone: 575-791-9712
  • Fax: 575-784-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: