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NPI Code Detail

MEDICARE: DEBORAH NEVAREZ-VIVOLO

MEDICARE: DEBORAH NEVAREZ-VIVOLO
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
1106H00000XMarriage & Family Therapist122545CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17708OTHERCAMEDI-CAL
27184OTHERCAMEDI-CAL
37368OTHERCAMEDI-CAL
47667OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1265820575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH NEVAREZ-VIVOLO
Provider Business Mailing Address
First Line : 14890 JEREMIE ST
Second Line :
City : BALDWIN PARK
State : CA
Zip : 91706-5628
Country : US
Telephone Number : 626-485-0424
Fax Number :
Provider Business Practice Location Address
First Line : 21125 CENTRE POINTE PKWY
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91350-2994
Country : US
Telephone Number : 855-435-3801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2015
Last Update Date : 03/13/2025

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Directions to “ DEBORAH NEVAREZ-VIVOLO ” Practice Location

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