Healthcare Provider Details

I. General information

NPI: 1316850639
Provider Name (Legal Business Name): VIVAMA NURSING & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12281 KEENLAND DR
RANCHO CUCAMONGA CA
91739-9062
US

IV. Provider business mailing address

12281 KEENLAND DR
RANCHO CUCAMONGA CA
91739-9062
US

V. Phone/Fax

Practice location:
  • Phone: 310-709-6042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN CHIZOMAM CHUKWUOCHA
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 310-709-6042