Provider Demographics
NPI:1699032805
Name:ARANEZ, VIVIAN T (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:T
Last Name:ARANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19582 BEACH BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5924
Mailing Address - Country:US
Mailing Address - Phone:499-791-3202
Mailing Address - Fax:714-477-8088
Practice Address - Street 1:19582 BEACH BLVD STE 370
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5924
Practice Address - Country:US
Practice Address - Phone:949-791-3202
Practice Address - Fax:714-477-8088
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA166595207K00000X
NY280355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699032805Medicaid