LA VIDA MULTISPECIALTY MEDICAL GROUP INC (NPI# 1861522708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861522708 |
| Entity Type | Organization |
| Organization Name | LA VIDA MULTISPECIALTY MEDICAL GROUP INC |
| Practice Address |
4455 W 117th St Hawthorne CA 90250-2241 |
| Mailing Address |
Department 2834 Los Angeles CA 90084 |
| Practice Telephone | 3102148677 |
| Practice Fax Number | 3109211718 |
| Mailing Telephone | 3102148677 |
| Mailing Fax Number | 3109211718 |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. CHRISTOPHER C CHIDI (PRESIDENT) |
| Authorized Official Telephone | 3102148677 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 22234 | CA | Other Service Providers |
| Street Address |
4455 W 117TH ST |
| City | HAWTHORNE |
| State | CA |
| Zip Code | 90250-2241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235130832 | Fox Hills Pharmacy Inc | Pharmacy | 4455 W 117th St, Ste 101, Hawthorne, CA 90250-2241 | 2005-08-03 |
| 1457993792 | Tasha Dutil | Occupational Therapist | 4455 W 117th St, Hawthorne, CA 90250-2241 | 2019-10-08 |
| 1952960452 | Tanya Barton Henry | Pharmacist | 4455 W 117th St, Hawthorne, CA 90250-2241 | 2019-06-07 |
| 1245714716 | Patrick Knisley | Speech-Language Pathologist | 4455 W 117th St, Hawthorne, CA 90250-2241 | 2018-09-20 |
| 1821400490 | Jennifer Moreno Prior | Physician Assistant | 4455 W 117th St, #300, Hawthorne, CA 90250 | 2014-05-29 |
| 1427370733 | Maya Elena Wille | Pediatrics | 4455 W 117th St, Suite 300, Hawthorne, CA 90250-2241 | 2010-02-28 |
| 1427218510 | Karen Elizabeth Courtney | Registered Nurse | 4455 W 117th St, Hawthorne, CA 90250-2241 | 2008-06-11 |
| 1912189663 | Tahira Stewart | Family Medicine | 4455 W 117th St, #300, Hawthorne, CA 90250-2241 | 2007-12-04 |
| 1396945770 | Vanessa Laquinte Neal | Specialist | 4455 W 117th St, Hawthorne, CA 90250-2241 | 2007-07-23 |
| 1629192133 | Shereen Beverly, M.d. Inc. | Obstetrics & Gynecology | 4455 W 117th St, Suite 506, Hawthorne, CA 90250-2241 | 2007-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508479627 | Alexis Lemmon | Dental Hygienist | 13450 Hawthrone Blvd, Hawthorne, CA 90250 | 2020-08-28 |
| 1336620459 | Lan Ngoc Ton | Dentist | 13450 S. Hawthorne Blvd, Hawthorne, CA 90250 | 2018-08-27 |
| 1356829261 | Karneth Health Inc | Internal Medicine | 4512 W. Imperial Hwy, Ste B, Hawthorne, CA 90250 | 2018-08-02 |
| 1225524663 | Viridian Healthcare LLC | In Home Supportive Care | 13658 Hawthorne Blvd Ste 201, Hawthorne, CA 90250 | 2018-07-09 |
| 1235636044 | Sonia Medical Center Inc | Clinic/Center | 4512 W Imperial Hwy, Hawthorne, CA 90250 | 2018-04-09 |
| 1518484807 | Jessica Anne-marie Auzenne-harris | Nurse Practitioner | 12618 Hawthorne Blvd, Hawthorne, CA 90250 | 2017-08-28 |
| 1669993358 | Ololade Olamide Obafemi | Nurse Practitioner | 12954 Hawthorne Boulevard, Suite 104, Hawthorne Morningside Medical Clinic, Hawthorne, CA 90250 | 2017-07-03 |
| 1588194534 | Marissam Medical Inc. | Durable Medical Equipment & Medical Supplies | 13508 Inglewood Ave, Hawthorne, CA 90250 | 2017-06-13 |
| 1043751886 | Ogbonna Iwuamadi Olelewe | Nurse Practitioner | 11712 S. Hawthorne Blvd, Hawthorne, CA 90250 | 2017-03-13 |
| 1952758898 | La Shada Kai Martin | Contractor | 13010 Kornblum Ave, Unit D, Hawthorne, CA 90250 | 2016-05-20 |
| Find all providers in zip 90250 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| 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. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225512114 | Lauren Palma | Specialist | 178 Broad St, Hawthorne, NY 10532-1015 | 2018-09-18 |
| 1073968715 | Crista Marina Ana Lucia Rosborough | Specialist | 21403 Se 70th Ave, Hawthorne, FL 32640 | 2016-05-02 |
| 1083031447 | Laura R Wisniewski | Specialist | 118 Philip Pl, Hawthorne, NY 10532-2108 | 2014-03-24 |
| 1497191845 | Marta Alfano | Specialist | 507 Lafayette Ave, Hawthorne, NJ 07506-2424 | 2013-05-13 |
| 1710132519 | Melissa Infantino | Specialist | 86 Newman Ave, Hawthorne, NY 10532-1133 | 2008-11-20 |
| 1639362866 | Elizabeth Landrus | Specialist | 119 Bakers Acres Dr, Hawthorne, FL 32640-4159 | 2007-08-21 |
| 1215120621 | Susan Perko | Specialist | 100 Sunset Strip Dr, Hawthorne, FL 32640-4243 | 2007-08-20 |
| 1093935942 | Patricia L Carnival | Specialist | 5310 W 138th St, Hawthorne, CA 90250-6430 | 2007-04-25 |
| 1821120312 | Ocean View Specialists | Specialist | 13624 Hawthorne Blvd Ste 201, Hawthorne, CA 90250-5818 | 2007-03-10 |
| 1093859423 | Avner Manzoor Mandel M.d. A Medical Corporation | Specialist | 4477 W 118th St Ste 302, Hawthorne, CA 90250-2258 | 2007-02-18 |
| Find all providers in HAWTHORNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.