Mavis, Sam

Mavis, Sam is an individual health care provider with primary practice located at 12450 Van Nuys Blvd , Pacoima CA 91331-1391. She recently has only one registered license in Student, Health Care / Student in an Organized Health Care Education/Training Program, which is considered as her primary health care specialty. Mavis, Sam can be contacted via phone (818) 896-1161.

Contact Information

Primary practice address
12450 Van Nuys Blvd Pacoima CA 91331-1391
Phone: (818) 896-1161
Fax: (818) 896-5069
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1043738370
LBN Legal business name Mavis, Sam
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2017
Last updated Jul 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043738370 NPPES
California MEDICAID 7420
California MEDICAID 6758
California MEDICAID 7068

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