Mavie Clinic Professional Nursing Corporation
Nurse Practitioner, Family in Patterson, CA. Organization (NPI-2).
Details
- NPI
- 1245189190
- Entity type
- Organization (NPI-2)
- Legal business name
- Mavie Clinic Professional Nursing Corporation
- Organization subpart
- No
- Enumeration date
- Jan 23, 2026
- Certification date
- Jan 26, 2026
- Last updated
- Jan 26, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Other names
- Mavie Clinic (Doing Business As)
Practice location
109 Portrait LnPatterson, CA 95363-8341
Phone 209-806-4841 · Fax 209-290-3320
Mailing address
109 Portrait LnPatterson, CA 95363-8341
Phone 209-806-4841 · Fax 209-290-3320
Authorized official
Mukhtar Kohistani
President
2098064841
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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