Healthcare Provider Details

I. General information

NPI: 1457510836
Provider Name (Legal Business Name): VIVIAN G LONZANIDA CMP EMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 01/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GEORGIA ST SUITE 230
VALLEJO CA
94590-5946
US

IV. Provider business mailing address

301 GEORGIA ST SUITE 230
VALLEJO CA
94590-5946
US

V. Phone/Fax

Practice location:
  • Phone: 707-655-0454
  • Fax: 707-647-2604
Mailing address:
  • Phone: 707-647-2604
  • Fax: 707-647-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number09-00006549
License Number StateCA

VIII. Authorized Official

Name: MS. VIVIAN GRACE LONZANIDA WAS AKA CRUZ
Title or Position: LLC/SOLE PROP
Credential: CMP, EMT,CMT
Phone: 707-655-0454