MEDICARE: FELIPE VALLORINI VIVACQUA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	112205	CA

General Provider Information

NPI Number	:	1003791369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIPE VALLORINI VIVACQUA DDS

Provider Business Mailing Address
First Line	:	1441 S BEVERLY GLEN BLVD APT 324
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-6147
Country	:	US
Telephone Number	:	310-920-9126
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 1109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2014
Country	:	US
Telephone Number	:	310-920-9126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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