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
Certification Date: 2023-06-08
Details
Name | Value | ||||||||
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NPI | 1962529024 | ||||||||
Enumeration Date | 2007-03-23 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
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 | ||||||||
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