Healthcare Provider Details

I. General information

NPI: 1669383980
Provider Name (Legal Business Name): VIVIAN AGUAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WILSHIRE BLVD
LOS ANGELES CA
90017-3409
US

IV. Provider business mailing address

2810 N CHURCH ST # 33954
WILMINGTON DE
19802-4447
US

V. Phone/Fax

Practice location:
  • Phone: 626-686-1674
  • Fax:
Mailing address:
  • Phone: 626-686-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4525476
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: