Healthcare Provider Details

I. General information

NPI: 1295645703
Provider Name (Legal Business Name): MY VIVA MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 LITTLE STAR DR
RENO NV
89511-7310
US

IV. Provider business mailing address

940 LITTLE STAR DR
RENO NV
89511-7310
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YAZEN JOUDEH
Title or Position: PRESIDENT
Credential: MD
Phone: 775-564-2524