Provider Demographics
NPI:1083937148
Name:SHADD, VIVIEN TALOSIG (MSN, FNP-BC,CDE)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:TALOSIG
Last Name:SHADD
Suffix:
Gender:F
Credentials:MSN, FNP-BC,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22311 RUNNYMEDE ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1023
Mailing Address - Country:US
Mailing Address - Phone:818-456-7582
Mailing Address - Fax:818-713-1873
Practice Address - Street 1:1800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3602
Practice Address - Country:US
Practice Address - Phone:213-484-9934
Practice Address - Fax:213-484-9939
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA559188163WD0400X
CA19568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator