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Organization

LA VIDA MULTI-SPECIALTY MEDICAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHRISTOPHER C CHIDI MD (PRESIDENT)
(310) 214-8677
Entity
Organization

Contact information

Practice address
605 W. 6TH STREET, SAN PEDRO, CA 90731
(310) 241-0330
(310) 241-0719
Mailing address
DEPARTMENT NO 2834, LOS ANGELES, CA 90260
(310) 214-8677
(310) 921-1718

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
476247-04
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0088194
CA
Enumeration date
01/25/2007
Last updated
08/22/2020
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