Healthcare Provider Details

I. General information

NPI: 1932754140
Provider Name (Legal Business Name): VIVAKESO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 NE 152ND AVE
VANCOUVER WA
98684-7887
US

IV. Provider business mailing address

2718 NE 152ND AVE
VANCOUVER WA
98684-7887
US

V. Phone/Fax

Practice location:
  • Phone: 817-723-1462
  • Fax:
Mailing address:
  • Phone: 817-723-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ALEXIS ARNOLD
Title or Position: OWNER
Credential: RPSGT, RST, CCSH
Phone: 817-723-1462