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General NPI Number Information
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NPI Number | 1790428464
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Entity Type | Individual
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Provider Name | JOAN GIVENS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 25400 ALESSANDRO BLVD STE 105
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City | MORENO VALLEY
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State | CA
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Zip | 92553-4319
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Country | US
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Telephone | 951-570-0043
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Fax |
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Provider Business Mailing Address
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Address Line | 16312 CALLE AURORA
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City | MORENO VALLEY
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State | CA
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Zip | 92551-2053
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Country | US
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Telephone | 951-251-1142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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