=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720375835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIVA MED LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2011
-----------------------------------------------------
Last Update Date | 07/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15701 TULSA ST
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344-5524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-379-5738
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15701 TULSA ST
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344-5524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-379-5738
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MRS. VICTORINE FOMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-379-5738
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 5524
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------