Provider Demographics
NPI:1194121590
Name:BIVINS, JAMES (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BIVINS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-837-8767
Mailing Address - Fax:760-837-8806
Practice Address - Street 1:39700 BOB HOPE DR STE 216
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7109
Practice Address - Country:US
Practice Address - Phone:760-837-8767
Practice Address - Fax:760-837-8806
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB9360838OtherDRIVERS LICENSE