Jodivon Lee Fairclough, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN716238 Issued in CA

Practice address

5300 Angeles Vista Blvd
View Park, CA 90043-1648

Phone

(323) 295-4555

NPI assigned

Jun 4, 2021

Last updated

Jun 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1801463393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 GRACE AVE APT 1",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011339",
            "telephone_number": "424-541-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 ANGELES VISTA BLVD",
            "city": "VIEW PARK",
            "state": "CA",
            "postal_code": "900431648",
            "telephone_number": "323-295-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRCLOUGH",
        "first_name": "JODIVON",
        "middle_name": "LEE",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-04",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN716238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Duckworth
• Randle Claude Ellington II, LVN
• Empowered for Excellence Behavioral Health California LLC
• Empowered for Excellence Behavioral Health California LLC
• Yamely Espinosa Salas
• Yordanos Feleke
• Andrea Nicole Fennewald
• Lacey Finkelstein
• Christopher Gabriel Flores
• Lizvette Flores

• Licensed Vocational Nurse in View Park, CA
• Providers in View Park, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.