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NPI Code Detail

MEDICARE: MR. KYLE VIVO PA-C

MEDICARE: MR. KYLE VIVO PA-C
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
1363AM0700XMedical Physician Assistant18774CA

General Provider Information

NPI Number : 1407982689
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KYLE VIVO PA-C
Provider Business Mailing Address
First Line : 2126 MOZART ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-2246
Country : US
Telephone Number : 626-674-8109
Fax Number :
Provider Business Practice Location Address
First Line : 311 WINSTON ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90013-1519
Country : US
Telephone Number : 213-893-1960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2007
Last Update Date : 07/08/2007

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Directions to “ MR. KYLE VIVO PA-C” Practice Location

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