Provider Demographics
NPI:1134662166
Name:LABBAD, VIVIAN SUZANNE (LPT)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:SUZANNE
Last Name:LABBAD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14506 JEREMIE ST APT D
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4366
Mailing Address - Country:US
Mailing Address - Phone:626-354-4243
Mailing Address - Fax:
Practice Address - Street 1:2610 INDUSTRY WAY
Practice Address - Street 2:A
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4283
Practice Address - Country:US
Practice Address - Phone:310-631-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37931167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician