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Organization
PROTOTYPES
Active
Organization
PROTOTYPES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY HAVIG LVN (PSYCHIATRIC NURSE)
(909) 398-4383
Entity
Organization
Contact information
Practice address
2555 E. COLORADO BLVD, SUITE 100-101, PASADENA, CA 91107
(626) 577-2543
Mailing address
831 EAST ARROW HIGHWAY, POMONA, CA 91767
(909) 398-4383
(909) 398-0127
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN240811
CA
Other
Enumeration date
09/22/2011
Last updated
06/28/2013
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