Healthcare Provider Details

I. General information

NPI: 1134839301
Provider Name (Legal Business Name): VIVEAMIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LA TERRAZA BLVD
ESCONDIDO CA
92025-3875
US

IV. Provider business mailing address

500 LA TERRAZA BLVD
ESCONDIDO CA
92025-3875
US

V. Phone/Fax

Practice location:
  • Phone: 866-831-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BILAL SEADAN
Title or Position: CEO
Credential:
Phone: 866-831-1234