Provider Demographics
NPI:1376957688
Name:SAMPICA, VIVIEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:VIVIEN LEE
Middle Name:
Last Name:SAMPICA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 NEWPORT AVE
Mailing Address - Street 2:UNIT 19
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2744
Mailing Address - Country:US
Mailing Address - Phone:714-335-4603
Mailing Address - Fax:
Practice Address - Street 1:17332 IRVINE BLVD STE 295
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3098
Practice Address - Country:US
Practice Address - Phone:714-544-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor