Healthcare Provider Details

I. General information

NPI: 1114868791
Provider Name (Legal Business Name): MY VIVA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 95TH ST STE 123
NAPERVILLE IL
60564-9006
US

IV. Provider business mailing address

940 LITTLE STAR DR
RENO NV
89511-7310
US

V. Phone/Fax

Practice location:
  • Phone: 780-919-3436
  • Fax:
Mailing address:
  • Phone: 775-564-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOREEN WALES
Title or Position: CEO
Credential:
Phone: 775-564-2524