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Individual

TYWILA REEVES BIVENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
976 PICADOR BLVD, SAN DIEGO, CA 92154
(619) 271-5493
Mailing address
976 PICADOR BLVD, SAN DIEGO, CA 92154
(619) 271-5493

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
00711222
CA

Other

Enumeration date
12/17/2010
Last updated
12/17/2010
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