Provider Demographics
NPI:1730546847
Name:XAVIER, AUDREY ANN
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ANN
Last Name:XAVIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 STERLING PKWY
Mailing Address - Street 2:#100
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7300
Mailing Address - Country:US
Mailing Address - Phone:916-543-3377
Mailing Address - Fax:916-543-3375
Practice Address - Street 1:711 STERLING PKWY
Practice Address - Street 2:#100
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7300
Practice Address - Country:US
Practice Address - Phone:916-543-3377
Practice Address - Fax:916-543-3375
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies