Provider Demographics
NPI:1376947069
Name:DJAVID, VANIA
Entity type:Individual
Prefix:
First Name:VANIA
Middle Name:
Last Name:DJAVID
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 1:1715 GLEN KIPPEN LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2870
Mailing Address - Country:US
Mailing Address - Phone:559-765-1818
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST STE 244
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2806
Practice Address - Country:US
Practice Address - Phone:949-334-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123899106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist