Provider Demographics
NPI:1992543201
Name:CAVERA, PORTIA PAIRES
Entity type:Individual
Prefix:MISS
First Name:PORTIA
Middle Name:PAIRES
Last Name:CAVERA
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 1:4259 W BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-9816
Mailing Address - Country:US
Mailing Address - Phone:559-892-9861
Mailing Address - Fax:
Practice Address - Street 1:4259 W BULLARD AVE APT 165
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-9822
Practice Address - Country:US
Practice Address - Phone:559-225-6100
Practice Address - Fax:559-248-5231
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268298164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty