Individual
MR. AUSTIN PAUL PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
1855 N FAIR OAKS AVE, PASADENA, CA 91103-1620
(626) 398-6300
Mailing address
455 W MONTANA ST, PASADENA, CA 91103-1327
(626) 808-4200
(626) 486-9693
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN259764
CA
Other
Enumeration date
05/20/2017
Last updated
05/20/2017
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