# LA VIDA HEALTH & WELLNESS CENTER OF GARDEN GROVE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619752292
- **Authorized official:** JORGE PEREZ DE TAGLE (CEO)
- **Authorized official phone:** (310) 962-4808

## Contact information

- **Practice address:** 12062 VALLEY VIEW ST STE 108A, GARDEN GROVE, CA 92845-1737
- **Practice address phone:** (805) 233-6419
- **Mailing address:** 12062 VALLEY VIEW ST STE 108A, GARDEN GROVE, CA 92845-1737
- **Mailing address phone:** (805) 233-6419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251G0304X | Geriatric Physical Therapist | — | NULL | Yes |
| 2251G0304X | Geriatric Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2023
- **Last updated:** 08/30/2023