Provider Demographics
NPI:1073693354
Name:WORN, VIVIAN EMILY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:EMILY
Last Name:WORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:EMILY
Other - Last Name:BELMUSTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1381 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3314
Mailing Address - Country:US
Mailing Address - Phone:707-431-8234
Mailing Address - Fax:707-431-1427
Practice Address - Street 1:8465 OLD REDWOOD HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8090
Practice Address - Country:US
Practice Address - Phone:707-431-8234
Practice Address - Fax:707-431-1427
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics