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General NPI Number Information
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NPI Number | 1780542993
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Entity Type | Organization
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Legal Business Name | VIVENZA MEDICAL GROUP APMC
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 118 S KENWOOD ST UNIT 503
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City | GLENDALE
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State | CA
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Zip | 91205-2689
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Country | US
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Telephone | 818-266-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 W LINCOLN AVE APT 10
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City | ANAHEIM
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State | CA
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Zip | 92801-6046
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Country | US
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Telephone | 818-266-1090
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | ASH CORDERO
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Credential |
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Telephone | 818-266-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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