Provider Demographics
NPI:1457510836
Name:VIVIAN G LONZANIDA CMP EMT LLC
Entity Type:Organization
Organization Name:VIVIAN G LONZANIDA CMP EMT LLC
Other - Org Name:VIVIAN G LONZANIDA CMP EMT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC/SOLE PROP
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:LONZANIDA WAS AKA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMP, EMT,CMT
Authorized Official - Phone:707-655-0454
Mailing Address - Street 1:301 GEORGIA ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5946
Mailing Address - Country:US
Mailing Address - Phone:707-647-2604
Mailing Address - Fax:707-647-2604
Practice Address - Street 1:301 GEORGIA ST
Practice Address - Street 2:SUITE 230
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5946
Practice Address - Country:US
Practice Address - Phone:707-655-0454
Practice Address - Fax:707-647-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-00006549305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1586325OtherINTERGRATED NEUROMUSCULAR RE-EDUCATION/CROSS COUNTRY EDUCATION
CA7253OtherCALIFORNIA MASSAGE THERAPY COUNCIL/ CERT. MASSAGE PRACTITIONER
4/3/07 7 ; 8/1/07OtherFAEMT.ORG/ CERT. LEVEL 1 AND 2 ENERGY MED TECH. LYMPHATIC DECOGESTIVE THERAPY