Healthcare Provider Details

I. General information

NPI: 1508408527
Provider Name (Legal Business Name): VIVIAN GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 N CORDOVA ST
BURBANK CA
91505-2219
US

IV. Provider business mailing address

1125 W 6TH ST
LOS ANGELES CA
90017-1833
US

V. Phone/Fax

Practice location:
  • Phone: 818-478-6611
  • Fax:
Mailing address:
  • Phone: 213-202-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: