Provider Demographics
NPI:1831300813
Name:LA VIDA MEDICAL & IPA
Entity Type:Organization
Organization Name:LA VIDA MEDICAL & IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:310-214-8677
Mailing Address - Street 1:4161 REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3306
Mailing Address - Country:US
Mailing Address - Phone:310-214-8677
Mailing Address - Fax:310-370-7299
Practice Address - Street 1:4161 REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3306
Practice Address - Country:US
Practice Address - Phone:310-214-8677
Practice Address - Fax:310-370-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01443171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID