Provider Demographics
NPI:1295986537
Name:SEDA, VIVIAN T (MS)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:T
Last Name:SEDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27285 BLUE SPRUCE PL
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1858
Mailing Address - Country:US
Mailing Address - Phone:818-747-3841
Mailing Address - Fax:
Practice Address - Street 1:27285 BLUE SPRUCE PL
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1858
Practice Address - Country:US
Practice Address - Phone:818-747-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1538-1235Z00000X
PR001048235Z00000X
FLSZ5446235Z00000X
CA11385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004038100Medicaid
FL004038100Medicaid