MEDICARE: LA VIDA MEDICAL & IPA

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	171W00000X	Contractor	01443	CA

General Provider Information

NPI Number	:	1831300813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA VIDA MEDICAL & IPA

Provider Business Mailing Address
First Line	:	4161 REDONDO BEACH BLVD
Second Line	:	SUITE 201
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3306
Country	:	US
Telephone Number	:	310-214-8677
Fax Number	:	310-370-7299

Provider Business Practice Location Address
First Line	:	4161 REDONDO BEACH BLVD
Second Line	:	SUITE 201
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3306
Country	:	US
Telephone Number	:	310-214-8677
Fax Number	:	310-370-7299

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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Directions to “LA VIDA MEDICAL & IPA ” Practice Location

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