Provider Demographics
NPI:1831952555
Name:AVIVA LLC
Entity type:Organization
Organization Name:AVIVA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULICICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED ACUPUNCTURI
Authorized Official - Phone:808-797-8721
Mailing Address - Street 1:5909 GANNET AVE # B
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3211
Mailing Address - Country:US
Mailing Address - Phone:808-797-8721
Mailing Address - Fax:
Practice Address - Street 1:99-209 MOANALUA RD STE 314
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4042
Practice Address - Country:US
Practice Address - Phone:808-797-8721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1053859603Medicaid
HI1477299485Medicaid