Healthcare Provider Details

I. General information

NPI: 1912861154
Provider Name (Legal Business Name): CLARIVIAN DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JUNIPER ST FL 3
PHILADELPHIA PA
19107-1316
US

IV. Provider business mailing address

100 S JUNIPER ST FL 3
PHILADELPHIA PA
19107-1316
US

V. Phone/Fax

Practice location:
  • Phone: 267-500-8283
  • Fax: 267-500-8283
Mailing address:
  • Phone: 267-500-8283
  • Fax: 267-500-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLENE FIELDS
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 267-500-8283