Provider Demographics
NPI:1063060390
Name:JIVRAJ, MAYUR ARVIND
Entity type:Individual
Prefix:
First Name:MAYUR
Middle Name:ARVIND
Last Name:JIVRAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 ESTACADA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-4686
Mailing Address - Country:US
Mailing Address - Phone:773-715-3337
Mailing Address - Fax:
Practice Address - Street 1:625 34TH ST STE 110
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2307
Practice Address - Country:US
Practice Address - Phone:833-678-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist