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General NPI Number Information
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NPI Number | 1598519357
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Entity Type | Organization
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Legal Business Name | VVID LLC
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 191 SAND CREEK RD # CA230
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City | BRENTWOOD
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State | CA
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Zip | 94513-2215
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Country | US
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Telephone | 925-663-8158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 786
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City | BETHEL ISLAND
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State | CA
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Zip | 94511-0786
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPHINE HARTS
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Credential | NP
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Telephone | 707-567-1674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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