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General NPI Number Information
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NPI Number | 1700027471
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Entity Type | Organization
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Legal Business Name | LA VIDA MEDICAL CV INC
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 4161 REDONDO BEACH BLVD # 300
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City | LAWNDALE
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State | CA
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Zip | 90260-3306
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Country | US
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Telephone | 310-214-8677
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Fax | 310-921-1716
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Provider Business Mailing Address
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Address Line | 4161 REDONDO BEACH BLVD # 300
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City | LAWNDALE
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State | CA
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Zip | 90260-3306
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Country | US
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Telephone | 310-214-8677
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Fax | 310-921-1716
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER CHIDI
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Credential |
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Telephone | 310-214-8677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | C3129855
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License Number State | CA
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