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NPI Code Detail

MEDICARE: MS. VIVIAN KO AIZPURU MFT

MEDICARE: MS. VIVIAN KO AIZPURU MFT
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 Therapist47034CA

General Provider Information

NPI Number : 1538285622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VIVIAN KO AIZPURU MFT
Provider Business Mailing Address
First Line : 1624 SANTA CLARA DR STE 145
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3500
Country : US
Telephone Number : 916-779-2434
Fax Number : 916-588-2880
Provider Business Practice Location Address
First Line : 1624 SANTA CLARA DR STE 145
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3500
Country : US
Telephone Number : 916-779-2434
Fax Number : 916-588-2880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 09/30/2016

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