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General NPI Number Information
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NPI Number | 1831300813
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Entity Type | Organization
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Legal Business Name | LA VIDA MEDICAL & IPA
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4161 REDONDO BEACH BLVD SUITE 201
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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 | 310-370-7299
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Provider Business Mailing Address
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Address Line | 4161 REDONDO BEACH BLVD SUITE 201
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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 | 310-370-7299
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTOPHER C CHIDI
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Credential | CEO
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 01443
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License Number State | CA
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