Provider Demographics
NPI:1578889499
Name:HIPOL GANTOUS, VIVIANNE (LAC, DIPLOM, RN)
Entity Type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:
Last Name:HIPOL GANTOUS
Suffix:
Gender:F
Credentials:LAC, DIPLOM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 BEN GUNN RD.
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-490-7555
Mailing Address - Fax:
Practice Address - Street 1:5269 GREENWICH RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6009
Practice Address - Country:US
Practice Address - Phone:757-490-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000449171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist