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NPI Code Detail

MEDICARE: MS. TANYA VIVAS MSW

MEDICARE: MS. TANYA VIVAS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker64418CA

General Provider Information

NPI Number : 1962529024
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TANYA VIVAS MSW
Provider Business Mailing Address
First Line : 1045 W REDONDO BEACH BLVD STE 300
Second Line :
City : GARDENA
State : CA
Zip : 90247-4175
Country : US
Telephone Number : 323-241-6730
Fax Number : 323-967-0614
Provider Business Practice Location Address
First Line : 1045 W REDONDO BEACH BLVD STE 300
Second Line :
City : GARDENA
State : CA
Zip : 90247-4175
Country : US
Telephone Number : 323-241-6730
Fax Number : 323-756-1163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 06/08/2023

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