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General NPI Number Information
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NPI Number | 1457510836
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Entity Type | Organization
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Legal Business Name | VIVIAN G LONZANIDA CMP EMT LLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 01/12/2013
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Provider Practice Location Address
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Address Line | 301 GEORGIA ST SUITE 230
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City | VALLEJO
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State | CA
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Zip | 94590-5946
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Country | US
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Telephone | 707-655-0454
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Fax | 707-647-2604
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Provider Business Mailing Address
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Address Line | 301 GEORGIA ST SUITE 230
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City | VALLEJO
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State | CA
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Zip | 94590-5946
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Country | US
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Telephone | 707-647-2604
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Fax | 707-647-2604
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Authorized Official
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Title or Position | LLC/SOLE PROP
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Name | MS. VIVIAN GRACE LONZANIDA WAS AKA CRUZ
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Credential | CMP, EMT,CMT
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Telephone | 707-655-0454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 09-00006549
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License Number State | CA
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