Provider Demographics
NPI:1982176947
Name:VANDIVER, ABRAHAM ALEJANDRO (FNP)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:ALEJANDRO
Last Name:VANDIVER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9109
Mailing Address - Country:US
Mailing Address - Phone:760-960-2663
Mailing Address - Fax:
Practice Address - Street 1:488 E VALLEY PKWY STE 411
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3380
Practice Address - Country:US
Practice Address - Phone:833-867-4642
Practice Address - Fax:360-462-2741
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA820909163W00000X
CA95011167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse