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LA VIDA MULTI-SPECIALTY MEDICAL GROUP NPI 1285789487


NPI Information

NPI: 1285789487
Provider Name: LA VIDA MULTI-SPECIALTY MEDICAL GROUP
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
605 W. 6TH STREET
SAN PEDRO, CA
ZIP 90731
Phone: (310) 241-0330
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LA VIDA MULTI-SPECIALTY MEDICAL GROUP is a specialist in San Pedro, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. LA VIDA MULTI-SPECIALTY MEDICAL GROUP NPI is 1285789487. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

605 W. 6TH STREET
SAN PEDRO, CA
ZIP 90731
Phone: (310) 241-0330
Fax: (310) 241-0719

The provider's authorized official is Christopher C Chidi .
The authorized official title is President and has the following contact phone number (310) 214-8677.

The enumeration date for this NPI number is 1/25/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist476247-04CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0088194MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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