Provider Demographics
NPI:1457641094
Name:VIVIANO CUSTOM SHOE COMPANY, INC.
Entity Type:Organization
Organization Name:VIVIANO CUSTOM SHOE COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:VIVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:818-292-8250
Mailing Address - Street 1:7801 CANOGA AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5019
Mailing Address - Country:US
Mailing Address - Phone:818-292-8250
Mailing Address - Fax:818-292-8690
Practice Address - Street 1:7801 CANOGA AVE STE 12
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5019
Practice Address - Country:US
Practice Address - Phone:818-292-8250
Practice Address - Fax:818-292-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101-697629332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6576890001Medicare NSC