Provider Demographics
NPI:1417739400
Name:SMITH, VIVICA DELORES
Entity Type:Individual
Prefix:
First Name:VIVICA
Middle Name:DELORES
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ORANGE ST SE APT 33
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1613
Mailing Address - Country:US
Mailing Address - Phone:202-534-6897
Mailing Address - Fax:
Practice Address - Street 1:800 SOUTHERN AVE SE APT 828
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4828
Practice Address - Country:US
Practice Address - Phone:202-534-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide