MEDICARE: VIVENZA MEDICAL GROUP APMC

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	207R00000X	Internal Medicine Physician
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1780542993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVENZA MEDICAL GROUP APMC

Provider Business Mailing Address
First Line	:	3311 W LINCOLN AVE APT 10
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-6046
Country	:	US
Telephone Number	:	818-266-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 S KENWOOD ST UNIT 503
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2689
Country	:	US
Telephone Number	:	818-266-1090
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	ASH CORDERO
Credential	:
Telephone Number	:	818-266-1090

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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