Healthcare Provider Details

I. General information

NPI: 1285380816
Provider Name (Legal Business Name): VIVIANA CHAVOYA CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14405 1/2 ORANGE AVE
PARAMOUNT CA
90723-3103
US

IV. Provider business mailing address

14405 1/2 ORANGE AVE
PARAMOUNT CA
90723-3103
US

V. Phone/Fax

Practice location:
  • Phone: 562-533-5301
  • Fax:
Mailing address:
  • Phone: 562-533-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: