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Provider Information for 1962529024


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Ms. TANYA VIVAS MSW


Sex: Female

NPI: 1962529024
Last Updated: 2023-06-08
Certification Date: 2023-06-08

Details

NameValue
NPI1962529024
Enumeration Date2007-03-23
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1045 W REDONDO BEACH BLVD STE 300
GARDENA, CA 90247-4175
United States

Phone: 323-241-6730 | Fax:323-967-0614
 
Primary Practice Address 1045 W REDONDO BEACH BLVD STE 300
GARDENA, CA 90247-4175
United States

Phone: 323-241-6730 | Fax:323-756-1163
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalCA64418