Provider Demographics
NPI:1730357286
Name:LAMM, AVA MARIE (LVN)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:MARIE
Last Name:LAMM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12398 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4452
Mailing Address - Country:US
Mailing Address - Phone:909-797-4333
Mailing Address - Fax:
Practice Address - Street 1:12398 CUSTER ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4452
Practice Address - Country:US
Practice Address - Phone:909-797-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN164574164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN004880OtherMEDI-CAL PROVIDER NUMBER
CAEPS016730OtherMEDI-CAL PROVIDER NUMBER
CACMCSUBQQ8OtherCMC ID