Healthcare Provider Details

I. General information

NPI: 1235573189
Provider Name (Legal Business Name): LISA MARIE VIAPIANO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 COLORADO AVE SUITE 120
SANTA MONICA CA
90404-3584
US

IV. Provider business mailing address

2425 COLORADO AVE SUITE 120
SANTA MONICA CA
90404-3584
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-2227
  • Fax:
Mailing address:
  • Phone: 310-829-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number32611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: