Provider Demographics
NPI:1932743192
Name:VIVA VELOCITY, LLC
Entity Type:Organization
Organization Name:VIVA VELOCITY, LLC
Other - Org Name:PEARL NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRESHA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:312-952-6012
Mailing Address - Street 1:12704 FANTASIA DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2941
Mailing Address - Country:US
Mailing Address - Phone:312-952-6012
Mailing Address - Fax:844-246-8462
Practice Address - Street 1:12330 PINECREST RD STE 125
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1655
Practice Address - Country:US
Practice Address - Phone:312-952-6012
Practice Address - Fax:844-246-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467705079OtherNPI