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General NPI Number Information
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NPI Number | 1740852763
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Entity Type | Organization
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Legal Business Name | LA VID CORPORATION
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 8273 WHITE OAK AVE STE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7671
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Country | US
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Telephone | 909-631-5768
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Fax |
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Provider Business Mailing Address
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Address Line | 523 W ELM ST
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City | ONTARIO
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State | CA
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Zip | 91762-5712
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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 | PRESIDENT
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Name | ARLYN MENDOZA
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Credential | LMFT
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Telephone | 909-631-5768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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