MEDICARE: LA VIDA MEDICAL CV INC

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	302R00000X	Health Maintenance Organization	C3129855	CA

General Provider Information

NPI Number	:	1700027471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA VIDA MEDICAL CV INC

Provider Business Mailing Address
First Line	:	4161 REDONDO BEACH BLVD # 300
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3306
Country	:	US
Telephone Number	:	310-214-8677
Fax Number	:	310-921-1716

Provider Business Practice Location Address
First Line	:	4161 REDONDO BEACH BLVD # 300
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3306
Country	:	US
Telephone Number	:	310-214-8677
Fax Number	:	310-921-1716

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER CHIDI
Credential	:
Telephone Number	:	310-214-8677

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/10/2009

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