Provider Demographics
NPI:1447385828
Name:VIVAS, HAZEL ELIZABETH
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:ELIZABETH
Last Name:VIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:NINETTE
Other - Last Name:VIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1123 I ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2482
Mailing Address - Country:US
Mailing Address - Phone:707-441-1654
Mailing Address - Fax:
Practice Address - Street 1:805 7TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1113
Practice Address - Country:US
Practice Address - Phone:707-445-1195
Practice Address - Fax:707-445-1802
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker