Provider Demographics
NPI:1104332873
Name:ERVIN, CARLA YAVETTE (CPT01008218)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:YAVETTE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:CPT01008218
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30042 MISSION BLVD # 121222
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7255
Mailing Address - Country:US
Mailing Address - Phone:510-585-1312
Mailing Address - Fax:
Practice Address - Street 1:1515 AURORA DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3105
Practice Address - Country:US
Practice Address - Phone:510-969-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT01008218246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty