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General NPI Number Information
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NPI Number | 1942987474
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Entity Type | Organization
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Legal Business Name | VIVANT HEALTH, PLLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 660 GLADES RD STE 140
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City | BOCA RATON
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State | FL
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Zip | 33431-6466
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Country | US
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Telephone | 561-800-4570
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Fax | 561-800-4580
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Provider Business Mailing Address
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Address Line | 10425 S LAGO VISTA CIR
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City | PARKLAND
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State | FL
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Zip | 33076-2970
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Country | US
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Telephone | 561-800-2601
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRASANTH GOGINENI
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Credential | MD
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Telephone | 561-800-2601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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