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NPI Code Detail

MEDICARE: VIVIANA CARBAJAL FNP

MEDICARE: VIVIANA CARBAJAL FNP
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
1363LF0000XFamily Nurse Practitioner95034642CA
2363LF0000XFamily Nurse Practitioner209019628IL

General Provider Information

NPI Number : 1659932028
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIANA CARBAJAL FNP
Provider Business Mailing Address
First Line : 3258 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2729
Country : US
Telephone Number : 773-629-8217
Fax Number :
Provider Business Practice Location Address
First Line : 6430 SELMA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-7311
Country : US
Telephone Number : 323-543-4433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2019
Last Update Date : 02/19/2026

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Directions to “ VIVIANA CARBAJAL FNP” Practice Location

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