Provider Demographics
NPI:1942987474
Name:VIVANT HEALTH, PLLC
Entity Type:Organization
Organization Name:VIVANT HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-800-2601
Mailing Address - Street 1:10425 S LAGO VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2970
Mailing Address - Country:US
Mailing Address - Phone:561-800-2601
Mailing Address - Fax:
Practice Address - Street 1:660 GLADES RD STE 140
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6466
Practice Address - Country:US
Practice Address - Phone:561-800-4570
Practice Address - Fax:561-800-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care